2015 Stall Reservation Request (February 1, 2015-February 1, 2016) Certified Producer Application Office Use Only Reg _____ Cert _____ PA _____ $ _____ Date _________________ Business Name: If using a Fictitious Name, attach copies of statements Owner Name: Contact Name (if different from owner): Mailing Address: Contact Person’s Data Cell Phone: This phone accepts text messages Email Address: Website: 2nd Phone: Fax Number: Producer Certification Number: _________________ Expiration Date: ___/___/___ Proposed 2nd Certification Number: _________________ Expiration Date: ___/___/___ Proposed 2nd Certification Number: _________________ Expiration Date: ___/___/___ PLEASE ATTACH COPY OF CERTIFIED PRODUCER CERTIFICATE(S) Will you be selling any processed foods? Yes ____ No ____; please attach health permit. Please check the box of the best method to reach you with an emergency at market: (choose one) Text Message: Phone: Email: Does your farm participate in WIC? Yes____ No____ I request permission to sell products I grow at the CFMA certified farmers’ markets. I will not resell products at these markets. I will receive a copy of the 2015 CFMA Market Rules & Regulations upon stall confirmation. I agree to observe and obey the terms and conditions set forth in the 2015 CFMA Market Rules and Regulations and CFMA Market Notices that may be periodically issued throughout the year by CFMA. I agree to abide by the due process and grievance/claim policies and procedures set forth in the 2015 CFMA Market Rules & Regulations. I agree to abide by the terms and conditions set forth in the enclosed Participation Agreement as indicated by my signature below and my signature located on the Participation Agreement on the reverse side. I agree to cooperate with the market manager, pay the required fees, pay any assessed fines/penalties, and submit a legible, complete and accurate load list(s) at the end of each market day. I understand my farm/business is scheduled for a season, and my stall participation is reserved in 30-day increments. Each 30-day renewal of selling privileges is automatic, unless negative compliance occurs, including, but not limited to: cooperation and positive relations with the market manager, quality of products, adherence to market rules and regulations, adherence to the State of California Uniform Retail Food Laws (CalCode), and adherence to the State’s direct marketing regulations. I agree that the market manager may adjust, limit, or increase the supply of the product(s) I offer for sale. I will provide the market manager a copy of my current embossed producer certificate prior to commencing sales at any CFMA certified farmers’ market. My signature below demonstrates that I am the Certified Producer and signifies my agreement with the above: ____________________________________________________ Signature of Certified Producer ______________________ Date 2015 Participation Agreement Certified Producer I hereby acknowledge receipt of and agree to observe and obey the California Farmers’ Markets Association (CFMA) 2015 CFMA Market Rules and Regulations, which are mailed upon confirmation , and CFMA Market Notices that may be periodically issued by CFMA. I agree to complete and submit a legible, complete and accurate certified producer/non-agricultural producer market load list(s) each market day of participation. I/We hereby agree, as a certified producer / non-certifiable agricultural producer at a CFMA’s certified farmers’ market, that I/we will indemnify and hold harmless the sponsors of the market site, the CFMA, their agents, directors and employees, from and against any and all liability, claims, demands, expenses, attorney’s fees and costs including expert consultant/witness fees, fines, penalties, suits, proceedings, actions and causes of action of any and every kind and nature arising or growing out of or in any way connected with my/our use or occupancy as a certified producer / non-certifiable agricultural producer at a CFMA certified farmers’ market. I hereby agree as a certified producer / non-certifiable agricultural producer participating in the CFMA certified farmers’ markets that I will maintain vehicle liability insurance, and where applicable, product liability insurance and worker’s compensation insurance, in effect while I am a participating in any CFMA certified farmers’ market. I hereby agree and understand the participation of my farm/business is scheduled on an annual/seasonal basis and my participation is not automatic and is reviewed each year. Selling privileges of my farm/ business are renewed in 30-day increments provided no negative compliance occurs. CFMA will base my renewal on many factors including, but not limited to: consistent reserved attendance, cooperation with the market manager, positive relations with the market manager, quality of products, volume sold of similar products, submission of completed load lists, adherence to the market rules and regulations, and adherence to the State of California direct marketing regulations and where applicable the State of California Uniform Retail Food Laws (CalCode). I will not utilize distributorships or commission payments to compensate for the sales of my products. I hereby declare that I have the authority to sign this acknowledgement/agreement as the participant or the participant’s representative. By signing this acknowledgement/agreement, I acknowledge that a representative(s) of CFMA is hereby given permission to visit the location(s) where my product(s) is/are produced and/or stored to verify compliance with the 2015 CFMA Market Rules and Regulations and the State of California’s direct marketing regulations. I agree that any dispute that arises between myself and the CFMA or between the participating farm/ business and CFMA and any other person(s) and /or entity(ies) related to the participation in CFMA markets shall be resolved by the process as outlined in the 2015 CFMA Market Rules and Regulations. I waive my right to a court or jury trial and agree to abide by and utilize the CFMA dispute resolution policies and procedures stated in the 2015 CFMA Market Rules and Regulations which shall be the sole method of resolving disputes. _____________________________________________________________________________ Signature Date __________________________________________________________________ Print Name _________________________________________________________________ Participating Business Other Non-CFMA Markets Please list markets you attend that are not operated by CFMA. Market Name City County Attach a separate sheet if needed to list more markets 2015 Application Fee Chart - Certified Producer Application fee is divided into 3 categories: I. Pay $25 if you qualify as a backyard grower. II. Pay $100 if you plan to attend 3 or less market locations per year. III. If you plan to attend 4 or more CFMA market locations this year, please pay the fee according to the number of markets you will attend. I. Backyard Grower Application Fee Small production area less than ¼ acre total. $25 II. Standard Non-Refundable Application Fee Attends 3 or less different market locations per year. Application fee is nonrefundable, but includes participation in 3 markets. $100 III. Multiple Market Participation Fee Attends 4 or more different market locations per year. Standard Application Fee + $ 50 per additional market. see below 4 markets = $100 + $50 $150 5 markets = $100 + $100 $200 6 markets = $100 + $150 $250 7 markets = $100 + $200 $300 8 markets = $100 + $250 $350 9 markets = $100 + $300 $400 10 markets or more $500 Enclose total 2015 fee $______ 2015 Stall Reservation Request Certified Producer Name: ____________________________________________ Date: __________________ Market Location Market Day/Time Market Season San Francisco Crocker Galleria Thursdays 11am-3pm Year Round Daly City Serramonte Center Thursdays 9am-1pm Year Round Los Altos Downtown Thursdays 4pm - 8pm May 7 Sept 24 Walnut Creek Rossmoor Fridays 9:30am-12pm May 15 October 30 San Leandro Bayfair Center Saturdays 9am-1pm Year Round Daly City Serramonte Center Saturdays 9am-1pm Year Round Walnut Creek Diablo Valley Saturdays 9am-1pm Year Round Gilroy City Hall Parking Saturdays 9am-1pm May 16 October 31 Morgan Hill Train Depot Saturdays 9am-1pm Year Round Saratoga West Valley College Saturdays 9am-1pm Year Round San Jose Blossom Hill Sundays 9am-1:30pm Year Round Sundays San Francisco Fort Mason Center 9:30am - 1:30pm Check Approx. Approx. Status to request Start Date End Date (Office Only) Year Round Moraga Moraga Center Sundays 9am-1pm Year Round Mountain View Train Station Sundays 9am-1pm Year Round Each market stall is reserved by the Market Manager.
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