HomeMy WebLinkAbout15-058 Peachtree Circle Farm r
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- 2015 Vendor Appiication ����u����
South Yarmouth Fa
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Howard Masonic Lodge, 20 Davis Road, South Yarmout HEALTH DEPT.
www.southyarmouthfallmarket.com
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Saturdays, October 3, 10, 17, 24, 31 and November 7, 14, 21 • 10 f�.�ll. to,�,2 F�M � " �x
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Name:—.:��'.�r�Y�L. Ef:��-�-� ;:
Business Name: ��� � � ��
Address: �� � ��� �� �`S�-
�1�M .�v"'�Y'� �"�
Website/Facebook: '�'��r c�.'�"e.�-r�.i'e-��'n�l r�"'" � �,�e.��"'iC- �
EmaiL• �✓Y"�-Cr�c�.��'����•��Telephone: ir�� i2i� ��i��'� Cell: ��"-�
Best way to contact you: ��`^�^� �'1�< �"� �'��y`A--
Name and contact for individual manning your space:_te4���--
Please list product(s)you intend to sell: �J-��s � ��� �- �/P� �-�� `'`�«� (�'�'�q=
The Market accommodates 24 vendors on a first-come first-reserved basis.
Spaces will be assigned by the Market Manager.
All fees payable in advance and as soon as possible to secure your 7'x7' space.
Full Season Fee: Saturdays$140. Per Day: $30 when/if space allows.
By signing this form vendor acknowledges that he/she has read and will comply with the guidelines for
�� the 2015 South Yarmouth Fall M e .
Applicants Signature: Date: �
Return completed application with payment payable to: South Yarmouth Fall Market
Mail to:
South Yarmouth Fall Market
c/o Carlene Veara
P.O. Box 293
Yarmouth Port, MA 02675-9998
Market Manager: Carlene Veara • Phone: 774-217-1067 • Email: rjvcbvf�aol.com
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THE COMMONWEALTH OF MASSACHUSETTS
TOWN OF YARN�OUTH
BOARD OF HEALTH
PERMIT NUMBER: #15-458 FEE: $50.00
This is to Certify that arrie Richter d/b/a Peachtree Circle F�rm
881 Palmer Avenue,�'almouth,MA
IS HEREBY GRANTED A LICENSE
For NAME OF EVENT: South Yarmouth Fall Market
D�TE OF EVENT• Saturda,y.�through to November 21, 2015.
LOCATION• Howard Masonic Lod�e 20 Davis Road South Yarmouth, MA
FOOD SERVED• Jams&,�ellies Veg�ies as available.
This permit is granted in conformity with Article VI of the Sanitary Code of The Commonwealth of Massachusetts,and
expires November 22.2015 unless sooner suspended or revoked.
October 5,2015 BOARD OF HEALTH: J pt'tl�.a 1�L�.fi¢a[(.�� ��LaiZ
� �53o�s��c�, _.11�.l�., ?Jice C,Puri�crtzan
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Eu.e�c�xi J.
B e G. urphy,MPH,R. ,C O
Director of Health
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��SCOTTSI�ALE INSURANCE CC}MPANY"
COMMERCIALGENERALLIABILITYCOVERAGE PART
SU PPLEM ENTAL DEC LARATIONS
PolicyNo. cPs2229os1 EffectiveDate 05l06I2015
12:01 A.M., Standard Time
Named insured p�AruTUFF CIRCLE FARM Agent No. 20007
Item 1. Limits of Insurance �'
Coverage Limit of Liability
Aggregate Limits of Liability ` Products/Completed
$ INC LUDED Operations Aggregate
General Aggregate(other than
$ 2,0 0 0, 0 0 o Products/Completed Operations)
Goverage A-Bodily Injury and any one occurrence sub}ect
Property Damage liability to the ProductsJ Completed
Operations and Generaf
$ ' l,o00, 000 AggregateLimitsofLiability
any one premises subject to the
Coverage A occurrence and
the General Aggregate Limits
Damage to Premises Rented to You Limit $ 5 0, o 0 0 of Liability
Coverage B-Personal and any one person or organization
Advertising Injury Liability subject to the General Aggregate ,
$ i,o 0 0, o 0 o Limits of Liability
Coverage C-Medical Payments any one person subject to the
Coverage A occurrence and
$ 5, o 0o tha Generai Aggrega#e l.imifs
Item 2. Description of Business
Form of Business:
� Individual ❑ Partnership L7 Joint Venture ❑ Trust ❑ Limited Liabitity Company
❑ Organization including a corporation (otherthan Partnership,Joint Venture orLimited Liability Company)
Location of All Premises You Own, Rent or Occupy:
See Schedule af Locations
Item 8. Forms and Endorsements
Form(s)and Endorsement(s} made a part of this policy at time of issue:
See Schedule of Forms and Endorsements
Item 4. Premiums
Coverage Part Premium: $ 925
Other Premium: $
Total Premium: � $ 9 z 5
THESE DECLARATIONS ARE PART OF THE POLICY DECLARATIONS CONTAINING THE NAME OF THE INSURED AND
THE POLICY PERIOD.
CLS-SD-1L(5-01) INSURED cle9dllf.fap
.