Midtown Public Market

Office Use Only
Application Approval ______Vender Fee ______Application Fee (one time) ______

Date of Payment ______Check# ______Cash______*************************************

I. Contact Information

Name First ______Last______

Address______City______Zip______

Business Name (If applicable)______

Farm /Business Address______City______Zip______(growers need to attach map of growing location)

Phone Number___(_____)______Email Address______

Farm / Business Website ______

Application Check List: The following items must be included with you application
□ Liability Insurance Policy Information / Release and Waiver Signature (details on page 2 of application)

□ Farmers’ Licensing Exemption Form: Required for anyone selling cultivated and harvested products
(form attached).

□ ST19 Tax Form: Complete and submit with application
All vendors must complete the ST19 Sales Tax form (attached). If you do not sell taxable items, check the box marked “I am selling only nontaxable items” and sign the bottom. If you do sell taxable items, you must fill in your MN Sales tax number (if you need a MN sales tax number, call 651-282-5225)

□ Growing Location Map (Growers Only): Draw/print a map to your field or growing location/s and attach it to this application. Indicate a major highway. Inspectors need this to locate your farm, fields, and/ or greenhouses.

□ Vending Schedule: Indicate which market you will be vending at on the market schedule form.

2008 Vendor Fees

Application Fee $25 One time application fee (applies to all vendors)

Season $350 June 1 - October 12 (20 Markets)

$50 of Season fee is refundable with a contribution of 5 on-site volunteer hours.

Monthly $75 Any 4 Consecutive Markets
Daily $20

Post Season Special Market $50 Non-Season vendors
Holiday Market 11/23/08 (Sunday) $25 Discount rate for paid Season vendors

II. License Certifications – Complete as applicable to your business
□ Are you selling any packaged, refrigerated or frozen foods for off-site consumption? □ Yes □ No

If yes, attach a copy of your Market Food Distributor License. License # ______

□ Are you selling or preparing foods for immediate consumption? □ Yes □No

If yes, attach a copy of your Market Food Manufacturer License. License # ______

□ Do you meet the requirements of Chapter 28A.15 Subd.10 (the “Pickle Bill”)? □ Yes □No
If yes, you must read and fully comply with the requirements outlined in the MN Department of Agriculture “Fact Sheet for Certain Home-processed and Home-Canned Foods” and be willing to provide any additional information requested by market staff. This fact sheet is available on the MN Department of Agriculture website, or by phone at 651-201-6064.

□ Organic Certification: Organic certification is not required. However; if you are certified please attach copy of certificate to the application.

□ MN Grown License # ______

Registration to use the MN Grown Logo to advertise your products costs only $5 per year. Call Brian Erickson with the MN Dept of Agriculture for more info: 651-296-4939

□ Farmers Market Nutrition Program # ______

You can get certified to accept FMNP vouchers for your produce by attending a training.. Call Carol Milligan, FMNP coordinator, for dates: 651-201-6606

III. Insurance and Liability
□ Release and Waiver. I hereby release, forever discharge and hold harmless the Kingfield Farmers' Market (Market), Kingfield Neighborhood Association (KFNA), Tom McKee, Biomedical Application of Minnesota, Inc. d/b/a Fresenius Medical Care, Kidney Specialist of Minnesota, Tim Harwig and Frame Ups and their successors and assigns, from any and all liability, claims and demands of whatever kind or nature, which arise or may hereafter arise from or in connection with my participation in the Kingfield Farmers' Market. I release and waive any claims against KFNA arising out my own conduct, and agree to defend and indemnify KFNA arising out of any such claims. I take full responsibility for my rented stall space at the market, my equipment and supplies, and all products that I bring to sell at the market. I understand that all vendors are strongly encouraged to carry their own product liability insurance.
I, ______(print name) understand and agree to the above paragraph.

______(signature) ______(date)

□ Product Liability Required: Vendors selling any kind of food (including produce) are required to demonstrate proof of Product Liability Insurance.
Insurance Company Name: ______
Policy Number ______Phone Number _(____)______
Agent ______Address ______
□ Workers Comp *If you do not carry Workers Comp. Insurance, state specific exemption: (i.e. Sole Proprietorship).

Insurance Company Name: ______
Policy Number ______Phone Number _(____)______

Agent ______Address ______

* Exemption Statement______

IV. Personnel

List all persons who will sell for you at the Kingfield Farmers' Market. Please update when you hire new people to work at the market.

V. Products and Produce

Growers: Please fill out the Crop List (attached) listing the products you will bring to the market (KFNA will accept a crop lists in another format if requested information is included).

Non Produce Vendors: Please list here all of the products that will be sold at the market.

You may attach a page if necessary.

VI. Agreement

The Kingfield Farmers' Market reserves the right to inspect your crops, greenhouses, kitchen, art studio, place of production. You may not sell at the Kingfield Farmers' Market until you have completed the market application, paid the vendor fee and have been approved for market participation.

I understand that I am only allowed to sell locally grown produce, locally produced food items and hand-made products at the Kingfield Farmers' Market. I will seek permission from the market coordinator to sell products that I did not grow or make myself and identify the product source to customers. I will not acquire products from others and sell them as if they were my own.

I have read and understand the rules of operation for conducting business at the Kingfield Farmers' Market. I agree to abide by these rules. I certify that all information given here is accurate.

X______

Signature of Vendor Date

Please indicate all crops / products you grow and sell at

The Kingfield Farmers' Market.

Vendor Schedule for Market Coordinator

Vendors are expected to attend all markets they designate on the schedule.
Vendors will loose their selling space if they are continually absent without notification.

Please check the markets that you will be attending.

Vendor Name: Phone # Product: Produce / Art / Service

Office Use Only:

Application Approval ______Vender Fee ______Date of Payment ______
Check# ______Cash______

Vender Fee ______Date of Payment ______
Check# ______Cash______

Vender Fee ______Date of Payment ______
Check# ______Cash______

Vender Fee ______Date of Payment ______
Check# ______Cash______

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