BFM office only: Rec’d___/___/___ Aprv’d __/___/___
Not Aprv’d Notified
INS exp ___/___/___ Lease ____/___to ____/___ WHS LIC exp___/___/___ Rtl Food LIC exp___/___/___ CO S Tax exp ___/___/___ CDPHE Egg exp ___/___/___ Org Cert exp___/___/___ Farm Map Crop List New Item List App. Fee
Check No.________ Amount___________
Broomfield Farmers’ Market at Holy Comforter Episcopal Church 2015 Vendor Application Dear Market Applicant, The Broomfield Farmers’ Market at Holy Comforter Episcopal Church (BFM) thanks you for your interest in being a part of our growing market. We are dedicated to creating a destination to connect area residents with healthy food and local farmers. Accordingly, we need to verify information about your business, and about the products you will be offering to our customers. This application may seem intimidating, but we need to capture specific information from farmer-vendors, vendors of prepared food products, and from all other vendors. The checklist below will help you determine the specific areas that you need to complete for your formal application for participation in the Broomfield Farmers’ Market at Holy Comforter Episcopal Church. Again, thank you for your interest in our market. If you have any questions regarding this application, please contact us at
[email protected] or at 303.594.4420. All the Best, The Broomfield Farmers’ Market Volunteer Managers Instructions: 1. All Vendors must complete items 1-4, and sign the application on Page 8. 2. Vendors of unprocessed agricultural products (farmer-vendors) must complete items 5-15*. 3. Vendors of value-added agricultural products and prepared foods must complete items 16-19*. 4. Completed applications and fees are due no later than one week before your first week as vendor at the market. 5. Vendors submitting applications prior to May 10, 2015 will receive a 5% discount on their booth fee. 6. All applications must be complete and signed before being approved. 7. Make all Checks payable to Broomfield Farmers’ Market at Holy Comforter (be sure to include electrical fee, if applicable). 8. Mail Application and payment to: Broomfield Farmers’ Market, c/o Holy Comforter Episcopal Church, P.O. Box 412, Broomfield, CO 80038. 9. Vendors of any food products must also be approved for participation by the City and County of Broomfield. *See Section 4 of the Market Rules and Regulations for a definition of Unprocessed Agricultural Products, Value-Added Agricultural Products and Prepared Food. Vendor Application- Broomfield Farmers’ Market at Holy Comforter Episcopal Church 2014 Market Season -- Page 1 of 8
All Vendors must complete Items 1-4 below, and sign Page 8. 1. Application Fee/Space Fee: Annual space fees are $100 for the first 10’ x 10’ booth, and $50 per additional 10’ x 10’ booths (up to a maximum of three booths). The space fee is due at the time of application. Vendors are required to remit to the Broomfield Farmers Market an additional fee weekly in the amount equivalent to 10% of gross sales for that week. The 10% vendor fee will include Broomfield City sales tax for vendors of unprocessed agricultural products and value-added agricultural products. That weekly fee will be at the conclusion of each market day. Of the 10% market fee, one-fifth will be dedicated to market promotional activities. Vendors applying for a once-monthly booth must complete the form on Page 7. Application/Space Fee Payment Attached: Check no. ________ Amount _________
2. Insurance: All Vendors are required to provide a Certificate of Liability Insurance in the amount of one million dollars or greater for each market attended. BFM must be named as an “Additional Insured” on the certificate ATTACHED exp ___/___/___ WILL SEND
3. Electrical needs: Vendors may have access to electricity for a fee of $60 for the season. That fee must be submitted with this application.
□ Yes, I will require access to electricity for my booth. 4. Application Information Person Completing App. Business/Farm Name Business/Farm Address Address
City/Town
Zip Code
Address
City/Town
Zip Code
Mailing Address
Telephone, Cell Phone, Fax Emergency Contact
Business: (____) _______________Cell: (____) __________________ Fax: (____) ____________________E.C: (____) __________________
Email Address Email Address:______________________________________ Product Category(s) (Sect. 4 Rules & Regs)
List all other Farmers’ Markets in which you participate
Check all categories that apply to your farm: ____Meat _____Fruit _____ Seeds ____Dairy _____Vegetables _____ Outdoor grower ____Eggs _____Flowers _____ Greenhouse ____Crafts _____ Potted plants _____Service ____Value Added: Processed/Regulated Products ____Prepared foods ____ Other (Specify) ________________________________________ ________________________________ ___________________________ ________________________________ ___________________________ ________________________________ ___________________________ ________________________________ ___________________________
Vendor Application- Broomfield Farmers’ Market at Holy Comforter Episcopal Church 2014 Market Season -- Page 2 of 8
Vendors of Unprocessed Agricultural Products must complete Items 5-15 below, and sign Page 8. (See definition of Unprocessed Agricultural Products in 4.A of our Rules & Regulations)
5. Crop List: List all crops you plan to grow with approximate square footage/acreage for each. Tree fruit growers must list specific varieties. For value-added products, processed products, and crafts, describe all products and identify what portion of the product is produced on the farm, gathered, and/or purchased. Remember, if it's not listed on your crop list, you can't display or sell it at the Market. ATTACHED
6. Farm Map:
Farm maps are required to assist BFM staff with inspections. Please attach one of the following for each farm/parcel on which crops sold at the Broomfield Farmers’ Market are grown. A sketched map on an 8-1/2 x 11" sheet of white paper showing the farm's size and location relative to roads and towns. OR A copy of a Google Maps, MapQuest or similar aerial photo with farm boundaries and roads clearly marked.
ATTACHED
7. Lease Agreement(s):
Vendors leasing land are required to submit a completed, signed copy of their Lease Agreement
AND the Lease Verification Agreement (page 3) for each leased parcel.
Lease:
ATTACHED ___/___/___to ___/___/___
WILL SEND
N/A
Lease Verification Agreement: ATTACHED ___/___/___to ___/___/___
WILL SEND
N/A
8. CDPHE Egg License:
Check with the Colorado Department of Public Health and Environment to see what licenses your
products require.
ATTACHED exp. ___/___/___
Operating under Cottage Food Act
WILL SEND
N/A
9. Organic Certification: ATTACHED exp. ___/___/___
WILL SEND
N/A
10. Broomfield City and County Approval ATTACHED exp. ___/___/___
WILL SEND
N/A
11. Farmer Vendor Information Agricultural Practice
Check One: ____Certified Organic (Must complete the Organic Declaration on page 2) ____Conventional ____ n/a
Farm Location(s)
List all counties in which market products are grown: __________ County
_____________ County
__________ County
_____________ County
Vendor Application_1 -- Broomfield Farmers’ Market at Holy Comforter Episcopal Church 2015 Market Season -- Page 3 of 8
12. Resale (If Applicable) Resale may only be conducted in accordance with Section 4a of the Rules and Regulations of the Broomfield Farmers’ Market at Holy Comforter Episcopal Church. If you resell any products at the Broomfield Farmers’ Market, please specify the steps you take to comply with Section 4A of the Rules and Regulations. ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ Product(s)
Source Farm/Location
Contact Information
Name:________________________________________ Phone:_______________________________________ Email_________________________________________
Name:________________________________________ Phone:_______________________________________ Email_________________________________________
Name:________________________________________ Phone:_______________________________________ Email_________________________________________
13. Organic Declaration (If Applicable) Vendors should be aware that pursuant to CFR Part 205, Subpart B, Section 205.100 (c)(1) any operation that knowingly sells or labels a product as organic, except in accordance with the Act, shall be subject to a civil penalty of not more than $11,000 per violation.
I will not be selling items at the market as “Organic”. 1.
I intend to represent my product(s) as “Organic”. I have included a copy of my certification with this application. I will also have a copy available for inspection at my stand. Certified by_______________________________ # Years _________ exp. ___/___/___
14. Farm Ownership Check all that apply: Do you own the land on which you farm? Do you lease any land on which you farm?
Yes No Yes No
If Yes, lease verification documents are attached
15. Lease Verification Document The BFM allows vendors to lease land and sell the products from that land at the Market. A lessee is required to have significant risk and financial investment in the leased land and its operation, as is the vendor doing most of the work, purchasing the plants and/or seeds, etc. BFM Rules are very specific regarding the leasing of land. Review Section 12 of the BFM Rules & Regulations before
Vendor Application_1 -- Broomfield Farmers’ Market at Holy Comforter Episcopal Church 2015 Market Season -- Page 4 of 8
completing this form. Use additional sheets if necessary. Attach a completed copy of this Lease Verification to your application for each leased parcel of land. Farm Name ________________________________________________________________________________________________ Your Name_________________________________________________________________________________________________ Phone Contact #_____________________________________________________________________________________________ Landowner (Lessor) Contact Info: (Name)_______________________________________________________________________ Phone # __________________________
Email___________________________________________________________
Describe your arrangement, the work done by all parties, payment process, etc. ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ Member (Lessee) signature ______________________________________________ Date _________ Landowner (Lessor) signature ____________________________________________ Date__________
Vendor Application_1 -- Broomfield Farmers’ Market at Holy Comforter Episcopal Church 2015 Market Season -- Page 5 of 8
Vendors of Value Added Agricultural Products and Prepared Food must complete items 16-19 below, and sign Page 8. (See definition of Value-Added Agricultural Products and Prepared Food in 4.B and 4.C of our Rules & Regulations)
16. Wholesale Food License: Check with the Colorado Department of Public Health and Environment to see what licenses your products require. If required, please submit a copy to the City and County of Broomfield*
ATTACHED exp. ___/___/___
WILL SEND
N/A
17. Retail Food License: Check with the Colorado Department of Public Health and Environment to see what licenses your products require. If required, please submit a copy to the City and County of Broomfield*
ATTACHED exp. ___/___/___
WILL SEND
N/A
18. Broomfield City and County Approval ATTACHED exp. ___/___/___
WILL SEND
N/A
19. Value Added Processed/Regulated Products List the Value-Added Products you will sell at the Broomfield Farmers’ Market: ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ Describe how your products comply with the provisions of Section 4B of the Rules and Regulations (produced in Colorado and/or made of products primarily grown or gathered in Colorado): ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________
20. For Vendors Operating Under the Cottage Food Act: Copy of Certificate of Training Attached
*Contact Information for the City and County of Broomfield Department of Health and Human Services: City and County of Broomfield Health and Human Services 6 Garden Center Broomfield, CO 80020 Office: 720-887-2232 Fax: 720-887-2229
[email protected] Vendor Application_1 -- Broomfield Farmers’ Market at Holy Comforter Episcopal Church 2015 Market Season -- Page 6 of 8
Signature Page By signing, I, the applicant, affirm the following:
I certify that all information provided in this application is accurate. I have read and agree to abide by the BFM Rules and Regulations. Failure to abide by BFM Rules and Regulations may result in forfeiture of all BFM member privileges and fees paid. 1. Release and Indemnity: I the undersigned hereby: Release and forever discharge the Broomfield Farmers’ Market, and its officers, employees and agents, from any and all claims of any kind whatsoever arising from or out of the participation of the undersigned in the Broomfield Farmers’ Market; and 2.
Agree to indemnify, save and hold harmless the Broomfield Farmers’ Market, its officers, volunteers and agents, against any and all liability, loss, costs, charges, obligations, expenses, attorney’s fees, judgments, damages, claims, and demands of any kind whatsoever arising from or out of the participation of the undersigned in the Broomfield Farmers’ Market. Printed Name: ___________________________________________
Signature: ______________________________________________
Title: ______________
Date: ______________
Optional: Please provide us with a brief paragraph about your farm/business that we can use in our promotional materials.
Please mail completed application to: Broomfield Farmers’ Market at Holy Comforter Episcopal Church P.O. Box 412, Broomfield, CO 80038 Ph. 303-466-2667 Fax 303-469-3349
[email protected] Vendor Application_1 -- Broomfield Farmers’ Market at Holy Comforter Episcopal Church 2015 Market Season -- Page 7 of 8
Pursuant to BFM Rules and Regulations: Agricultural products licensed, inspected, or otherwise regulated by the federal government, the State of Colorado, Broomfield County, or the City of Broomfield, may be sold only upon the Market’s receipt and acceptance of required documentation of compliance.
Vendor Application_1 -- Broomfield Farmers’ Market at Holy Comforter Episcopal Church 2015 Market Season -- Page 8 of 8