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HomeMy WebLinkAbout15-058 Peachtree Circle Farm r ,�g �c��j� - 2015 Vendor Appiication ����u���� South Yarmouth Fa 11 M r������� Howard Masonic Lodge, 20 Davis Road, South Yarmout HEALTH DEPT. www.southyarmouthfallmarket.com ;"°�'�, � �--� �� �r�. Saturdays, October 3, 10, 17, 24, 31 and November 7, 14, 21 • 10 f�.�ll. to,�,2 F�M � " �x ����'� � �� . . _ M . :��� y� r,� � 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 r k i � t �`= C � .. �.. 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F. .. �" V,M +!-,. ��� ^ � ��' � ;-�-3'�:} a �n : �t ` �,��_�� ���=► �� - , �.� � �{-� .�: �:�.��':� _ n.;� ,. , � � �Y ' -.,��,.� ��,-� G4'�-.>�C,�-'"�-G..,`�.:,��C�..%—�-���C:�l'."�-G;._.v`?�--,'--�-�.—��-?��-'-.��.. �� �. ., � , ,�, � �. � .� __:. �, �'�,, ,�rYi z -� U / +� s �� ��� � 1 ' �� -� � u;� ' � � � '' '�.v.�' � y; � � y�.,�, i� ,,..,�...�: r � �' r�� `� ��� * r��`� ' r��� � r � �� 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 � Eu.e�c�xi J. B e G. urphy,MPH,R. ,C O Director of Health I i I � � � , e'� W n --� � ; � w � � � � � �►.� � � � � � a . �, � � w � � � � � � � E-+ x`"�`-' � � A � °' � � o v� W � � g � � � � � w �D G� w � � � � v� ►v� � a��? a U � �i a � �,, � b O C "" � V � o *-� � � ,-, � � � � � � � u� � ;:� r/� ° v� w � ' � � EI-� W � � � � � � A � � �r cL3 o � �o � r.� � � H � � � � � � � O � � $-, ;� � � p � W o � � � . � @ H � � � � � � � � ° � ~' � C a � � Q-+ � ° � H a � � � � - o b > � � . a o � � � � N h �' � V � � � o � � � `E" ' � a � w � � � � � a� � o � o � � a oo � .� W � � � � � a . p,, � � .� � � � � � y '' := Q � � � � � � � � � � � � � � p� •� �+.� o �,, � a� � � .� � �C t� o � � � � +' � -r� � , � W �, Z �, a � � � .-., +� . � �s a� o � v � � � Q Z �° � ,� ►a � � F°-� a ' � � _. � �. ,���... _ , ., , �`�: �� . �,.��,i ,_�;, , ' ` � ��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 .