HomeMy WebLinkAbout15-015 Treasure by the Sea{
; �15-01�
� � 2015 Vendor Application ����o���
� �� MAY 14 2p 15
� (Processed & Potentially Hazardous Foods)
;
Bass River Farm Market HEALTH DEPT.
,:� � :�
311 Old Main Street, Bass River, MA 02664 � '%.��Z� �.
� �
2015 Market Dates: Thursdays,June 11-Sept. 17 9 AM-1:30�PM�
Saturdays,June 13-Sept. 19 9 AM- 1:30 PM
� 'hs
' Rain or Shine
I
i
! Name: � �p��,! �,n �#�� 10� (�n�a�o,
Farm/Vendor Name � 1�Qc��.ie 8�-t�z.. `��.. - �cn-nn � i ei l�
Farm/Business Address t b i►tlP;r �� � � �cz.lmrx.�-f� , M�4 o a���,�
�
Farm Website: �
Telephone (Work) (Home) ��s� 4RS-oa�-� (Celi)
Email: �e.1cn���emt�� ver+�a� . n f -
Best way to contact you �-mc� 1 �� ec��
Names of Designated Person(s� in charge seil�ng 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 iiaison for all correspondence between town officials(health, police,fire) and the
Market Manager. _
,�o�r.le�m.���ta,--t �ma� Phone �SC>�� 4 9 5- oa�f �l
Phone �°�)- `�4�� °��`Y
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.
..r�. l�
' 1. Please make your check payable to the,Bass River Farmers Market
2. Your 50% deposit+ Board of Heaith Fee of $50.00 * must be received
by April 30th 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 si�ning this form the vendor acknowledges that he /she has read
and wi11 comply with the guidelines for the 2015 BRFM which are
.
.
available on our website.
www.bassriverfarmersrnarke#.org (hard copies on request)
Applicants Signature �' i.�,�-, � -�
Date �- ��- �,5'
Please return completed application to:
Bass R�ver Farrners Market
PO Box 1374
South Yarmouth, MA 02664
Market Manager: Carlene Veara (774) 217-1067
�
�
� � , ' .
;
� � Samples Prov�ded? (Explain methods of serving samples: sizes, covered, iced?)
i
; --
�
�
; Where will food be prepared?
�
Check & attach copies with application:
�.. Copy of most recent inspection report of facility where food is prepared � ,;�
Product Liability Insurance
�-----�ServSafe Certification
' �-food Allergy Awareness Training Certi�cation
_ G.A.P.Training Certificate (Required as of 2011)
I _ Complete and attach Workers Compensation Affidavit.
Attach State Shell�sh Certificate, if applicable
I Any additional items must be approved by the Health Director prior to being �
� sold at the BRFIVI. 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 Both Days - $375
Saturdays — $200.00
A 50%non-refundable deposit is due by Apri130, 2015. Final payment is due by May 20, 2015.
All full-season vendors are expected to attend weekly. If a seasonal vendor does not show up
at a Market and has not given notice to the Market Manager,that vendar will receive notice
from the Market ManageK that his/her space is forfeited for the rernaining season.There ace
no refunds.
Educators, Master Gardeners, No charge
NON PROFIT and Authors and Sustainable Living
EDUCATIONAL GROUPS advocates to share and display
their knowledge and work.
� Must be approved by the Market
Manager
1
I
i '
I
i
�
! .,.
�
� ------ �-- __ ___ _. — _ . __- --
,I
����
--•�.... �
Cert�ficate af Achievement
� �J
��
1
This certificate is awarded to
iosenh I°�-- -
� Congratulationsl You have completed
�,,,,�,,�„ ServSafe� Food Handler
� �'�' Employee Food Safe#y Online Course and Exam
( ' .
f �tONA.t. �„��-�tp v,�,�. 1 n����s ,�N 4/19/2013
I RESTAURANT ----
ASSOCIATION� F,r,�„,,„,a,, 4f 1 A/�n 1 R
I 175 W:ackson Bivd;Ste 1500
Chicago++L 60604-281d
�.800765.2122 , = .�� �°-�:., .
� ��:vw.restauranl org�www.ServSafe.com . �;�,��, , ,,,_;;�� ,.. � `:�� . „ ..��:�,`, .:��� �.�� �.,, ,,
" , .
�
r
��� r� y.�,,e. � y���.c � �Y�c � S'�.'`�� � �n�c
' v t-� j� -s r n� ` >,� � r n �. e� .�� 5 .r � � . . � .� � � . � i
n n :`��.
� r �.�'�`G��-C.��`�G'�9•C.�'�`��9-e�J`'G��-elJ`'G��'' �`�'�
�, .:..:......�_.�., _.� ,�.�s�.�,z.,���>>�.,� „
�-�...., . ..........::. . :. ..... ..r,- - .,
.�� : ,��:
r ��;
. �4 ►
� �
;-l.����� �nc���--.
r, r �
M `�
� ��� YY
�<., , p � .:.�,.r-
� � �r ,A�
. �: \ - ,.
: �
� �
.�-.-E-����" ����'�
C ` •- :R>
!: :
�1 • „�` �Jj�y
♦ `� �.y `K
�C�. ► ^/ ��y,a
� � � � r`.+ �
�+ � ` \ .
�
� u � • �a
�:V ti . � ► :C��.� a;:
��.����G - r �
!'.
• s � -�'I
. s si „�`
��y. �
�b em .'j�
� {
�/C�.► � �
!' � �
�.�N � '.�
:-F�3�� �vfK��.',
� • �.>
� � � �• ��
, � �Yy
��,., � �-���
�.
,��r� ; r _
k +
�,�y �� '.,
�i4����� • ��'���'�.
�. C � � l'>
p ^( <.
� �= � �
•�-lc�.., t��>.*�
,�� . - ��,.
� �.
�.� a
;;���,�G ' ����-�=
<. � .>
, � - '�<�
�� �� Yy
�[,:. � � ..,a�
�r� =a�,
� ���
..��
�
� ,
._��,�31"� �CH�+i.
�n :,
{� f�� )Y
......���\��� �, . J /
�C�. �...,. - �.,....�.�, . ., ,s_.ss�.,:� . ....-,� � ..T'_'---r -:�r:-,�....n-�- .._....- :.:.,:: �. _,. ����..
.�
:� � .G\�,.fC�/c�'6��t,C./"�`.'G�..�t..rC/7c '6'�\��,C��•G�.��.,C/��. ��+
�� rU�-c t� rv�-c. � r�r. t� r�-c t� � rv�-c �7 r�c. `��.-.
���C y ,�"C y ��� } ���C ;}; ��� } `7���
r
�
i
�
�
� �
� .�
� THE COMMONWEALTH OF MASSAG'HUSETTS
� NiJMBER TOWN OF FALMOUTA �g
� 159-I S BOARD OF HEALTA �ZS
i
� PERMIT TO OPERATE A FOOD ESTABLISHMENT
I Fermit No.159-15 ''
Daie: January 2Q 2015
1n accordance with Reguiations promulgated under authority of Chapter 94,Section 305A and Chapter 1 l l,Section 5 of the General
Laws a Permit is hereby�anted to:
Treasure by the Sea
Whose place of business is: 10 Tiller Drive East Palmouth
Type of business and any restrictions: Residentiat Kitcden
"I'o operate a food establishment in:Falmouth
PF�rrExPmEs: December3l, 2Q15
David Cari-gnan—Health Ageat
Falmouth Board of Health
�
, , ` . �, � t i f��, ��.
� ,�
��°
� . � • �� �
,
� � � �
1 � ��' �`�
°��
� Y �
6y�a
j � �����
, � � :�
; `��� �
�� � k
,�,�'�x'
'. �t %
j . ?'j� ��sF��
5
1 � �
��� .
i � .
� � � 1
i
� •T�i � � }��� � I
•, ��� {
� ..� ��5� �4 � $t'�bt�
��r
I •� �' �
t'�� �
1 .� !' �l�
1
� ` S°k
�. � . . . � ��� �',� �. �.
; t
a +.� �
�' c
V'� ��
' � �
. .. � � � . . . .r� ���.,� � � �
(" x C ��' �
�t`
+c�, � �j . . �t � ', . .
� � �;�� �.,u . .
� � � �
� � �Ka
�tp 4 `
� �
w�..�� � � 'r� �� � �
. � � � . . . � . . �� . .
,.:�` ' !r
.�.. � U °
� � ���
�
a {
, � � /T
=� � �1--
� .�
EA :
� � `-=
�
�
:� ` _
�. . ��
, .�
, . � ���= �
�. �s,;
� � � i � ��.:�
� � � �:
,.� • �,�,
4 . . /.. ;P.. . � .
. r+ . \ / :*� � . .
wrr _Z. .
� .. � . �'+. . .
. ..^J'✓I�fJ'J.l./f1'1'.r � ��" �.
^ �
��e
tl�
� ;
x.,
. . �1 �,= ��� �
• C.__. ' .1`' :...
�
- . . � ::�.�'"d:, .. �.Gt. e� .
' ... . . >c:`
K- . . . . ,. , . • _... � , . .:
:.::.., ,c _<� . . �
'�`�A - /�� . .
.
_�` ..
1
(
i . � .
� �
l � � � � �
i .
i � � � � � � � �
j ' ,� . . � . � � � . . _- . . .
�
I • . . . . .` . . _
; 237 '
JEAN E TEMPESTA �-aa�n�s
DBA TREASURE BY THE SEA 9�s
10 TILLER DR y'�7'��
'' EAST FALMOUTH�MA 02638-4900 Date ' .
, .�--- $ 5C}.°�
Pay to the i/' T-�. o�'d a�S � �'{�
�eY Of T� �� s ,
� n� �oo -------_"". Dollars � a krs"o� �;
I ° �-----,
� QCKLANDTRUST
� � �� �
' ._ _ ..._�._����:�_-- __..�
, For ;
i �■ 0 237 �
�
�
; : � . �
,
,
t
�
�
,M.,.-.
�
--��....:�
,_ __._
' �\
�
� THE COMMONWEALTH OF MASSACHUSETTS
� TOWN OF YARMOUTH
� BOARD OF HEALTH
PERMIT NUMBER: #15-015 FEE: $50.00
�
� This is to Certify that Jean Temi esta, Joe .o go d/}�/a Treasure By The Sea
� 10 Tiller Drive, East FalmoLth, MA
;
� IS HEREBY GRANTED A LICENSE
' For NAME OF EVENT: Bass River Farmers Market
DATE OF EVENT: Thursda,ys and Saturday t ro gh to e�tember 19�.2�15.
LOCATION: 311 Old Main Street. South Yarmouth, MA
FOOD SERVED: Jams,jellv,and scones.
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.
� Mav 15.2015 BOARD OF HEALTH: J[uzr�.a 1�Cu�xteRuet, ��,�c�vureart
; :�'�i�axd J`3a�s��./lR..`l�., 21 ice C'f�ai�cnuzn
' Ei'�eecJ.rt.J-
J.
Bruce G. Murphy,MPH . ., CHO
i
Director of Health
� .
;
�
, _ __ _ - _
� _ ._ _ _
,
�
,
j .