HomeMy WebLinkAbout15-011 Englewood Baking Co.r
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� 2015 Vendor Application a� .�p��D
; {Processed & Potentially Hazardous Foo s) MAY '� 4 2�)15
Bass River Farm Market H��TH �EPT
; 311 Old Main Street, Bass River, MA 02664
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2015 Market Dates: Thursdays, June 11—Sept. 17 9 AM — 1:30 PM
Saturdays,June 13—Sept. 19 9 AM — 1:30 PM
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Rain or Shine � �. �
Name: �1 ���I�T��
Farm/Vendor Name K�' /
Farm/Business Address �f �'l��✓�� ' W� K���O�� � ����
Farm Website: WU�1Ul•�YI41���'��kIV�,C.��'Vi
Telephone (Work) (Home) �ag"�"�� (Cell)��3��
Email: ���(�� ��.U�Q��I,N�i ��Obli1
Best way to contact you ,���
Narnes of Designated Person{s) in charge selling at the BRFM*
*Person in charge is responsible for all operations and must be on site from 8:30 AM -1:30 PM
and be a liaison for all correspondence between town officials(health, police,fire) and the
Market Manager.
�l i Z����.���Qw1G(,V'�. Phone ,ci08�G53~53�`�
Phone
Produce/Product you will be selling:
(List all. Use separate page if needed. Packaged food items must have potential
allergens listed as well as ingredients). Labels should have vendors name and
address.
FreSl��-f'rozev� C�'o tissu��, bi�.ik-S,��ac�.i�., �i z�Gi-, t,c�t�(ak�S
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� Samples Provided? (Explain methods of serving sampies: sizes, covered, iced?)
; Y�5-u�i►��.Sv�le �.u,�s _ _
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'' Where wiil fQod be prepared?
' IZes���"�a� (Gi�QY�� C4� M�SS ���W ��O�.�uDV�-h.
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; Check &attach copies with application:
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Copy of most recent inspection report of facility where food is prepared ,
�w-
Product Liability Insurance
; V ServSafe Certification
I � Food Ailergy Awareness Training Certification
_ G.A.P.Training Certificate (Required as of 2011)
_ Complete and attaeh Workers Compensation Affidavit.
Attach State Shellfish Certificate, if applicable
Any additionai items must be approved by tMe Health Director prior to being
so{d at the BRFM. Please notify Market Manager at least one week in advance or
by 10 AM on Monday preceding the Thursday Market and she will get clearance
for you.
Full Season Fees ,_._—
Thursdays — $200.00 ays - $375
Saturdays — $200.00
A 50%non-refundable deposit is due by April 30, 2015. Final payment is due by May 2Q, 2Q15.
All full-season vendors are expected to attend weekfy. If a seasonal vendar does not show up
at a Market and has not given notice to the Market Manager,that vendor will receive notice
from the Market Manager that his/her space is forfeited for the remaining season.There are
no refunds.
Educators, Master Gardeners, No charge
NON PROFIT and Authors and Sustainable Living
EDUCATIONAL GRQUPS advocates to share and display
their knowledge and work.
Must be approved by the Market
Manager
' _ 1. Please make your check payable to the Bass River Farmers Market
2. Your 50% deposit+ Board of Health Fee of $50.00 * must be received
by April 30�" to reserve your space.
* Separate check made out to the Yarmouth Board of Health
3. All full season vendors must be paid in full by May 20th.
,;.
By signing this form the vendor acknowiedges that he /�he has read
and will comply with the guidelines for the 2015 BRFM which are
available on our website:
rwH�w.bassriverfarmersmarket.org (hard copies on request)
Applicants Signature � 1�.>
Date �I'��l�
Please return completed application to:
Bass River Farmers Market
PO Box 1374
South Yarmouth, MA 02664
Market Manager: Carlene Veara (774) 217-1067
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� � The Commonwealth of Massachusetts Fee
Town of Yarmouth �g�•�
� Food Establishment License
� Issue Date. 04/22/ZO15
Number: BUHF-15-1830
Mailing Address• Location Address:
ELIZABETH MCNAMARA 64 MASSACHUSETTS AVE
ENGLEWOOD BAKING COMPANY
WEST YARMOUTH.MA 02673
64 MASSACHUSETTS AVENUE
WEST YARMOUTH,MA 02673 `'�
IS gEREB�GRANTED A,2015 LYCENSE
TO OPERATE:
Residential Kitchen for Retail Sale �
This license is granted in conformity with the statutes and ordinances relating thereto,
and expires December 31,2015 unless sooner suspended or revoked �nd is not
transferable.
Con_ diti°ns
*RESTRICTION: Non-potentiatly hazarrlous fioods only.
Board Tanya Daigneault,Chairman
Hillard Boskey,M.D.,Vice Chairman
Of Mary Craig,Clerk
Evelyn P.Hayes
Health Charles T.Holway
ruce G.Murphy,MPH,R.S.,CHO/A .von Hone,R.S.,CHO
Health Director/Assistant Nealth Director
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' ` THE COMMONWEALTH OF MASSACHUSETTS
' TOWN OF YARMOUTH
BOARD OF HEALTH
; PERMIT NLJMBER: #15-011 : FEE: $50.00
�
; This is to Certify that F.li�abeth McN m r /a nglewood B king Comn�nv
j _ 64 Ma � Av n�e, We�t Y rmot�th, MA �
I IS HEREBY GRANTED A LICENSE
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� For NAME OF EVENT: Bass River Farmers Market
{ ATE OF EVENT• Th�r days �nd S���rda�� hr�i g n � PmhP ,�n�5
, LOCATION: 311 Old Main Street, South Yarmouth MA
� FOOD SERVED: Fresh& frozen croissants biscuits foraccia, pizza cupcakes
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� This permit is granted in conformity with Article VI of the Sanitary Code of The Commonwealth of Massachusetts,and
� expires September 20.2015 unless sooner suspended or revoked.
i Mav 15,2015 BOARD OF HEALTH: J[uuf.a 1�p,i�.�Ze�cuet, C�i[rvltrtaft
; �53cr.o��.l1Z..`1�., `?Iice C!Pcavuruut
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Bruce G. Murphy,MP , . ., CHO
Director of Health
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