St. Augustine Amphitheatre Farmer s Market. Vendor Application Instructions

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1 St. Augustine Amphitheatre Farmer s Market Vendor Application Instructions To be considered for participation in the St. Augustine Amphitheatre Farmer s Market, please submit: - Completed and signed Vendor Application - Signed Acknowledgement page from Standard Operating Procedures - Level I Background Screening Release of Information (Business Owner Only) - Copy of valid photo identification - Copy of applicable licenses and permits, including St. Johns County Business Tax Receipt - Signed Employee Release (if applicable) - $30 Non-Refundable Application Fee (cash or check) Mail to: Kathryn H Provow LLC St. Augustine Amphitheatre Farmer s Market PO Box 3832 St. Augustine, FL Call or with any questions: Katie Provow staampmkt@gmail.com

2 St. Augustine Amphitheatre Farmer s Market 2017 Farm, Food and Plant Vendor Application Contact Information: Name(s): Business Name: Mailing Address: Phone: Website: What do you sell? Be specific. List all licenses and permits under which your business operates: Do you carry liability insurance? How often do you wish to participate in this market? Do you have an off season? Please be specific. How many 10 x 10 stalls do you wish to operate? Do you wish to park at your stall? Vehicle type? Do you need electrical service? Please list specific electrical needs. Have you vended at the Amphitheatre market in the past?

3 If so: For how long have you been a vendor? Where in the market is/was your stall(s)? Are there other vendors you would like to be located near? If so, who? Do you vend at any other markets? If so, which? If there was a weekday/weeknight market organized, would you be interested in attending? Additional comments: Vendor Signature Date

4 Kathryn H Provow LLC LEVEL I BACKGROUND SCREENING AUTHORIZATION FOR RELEASE OF INFORMATION I, the undersigned, authorize the release to Kathryn H Provow, LLC and St. Johns County, FL any record or information concerning my driving record and any crime committed or alleged to have been committed by me. This includes, but is not limited to, arrest records and conviction data, and shall be deemed to include any updates, supplements, or revisions to such records that may be obtained during my continued participation with Kathryn H Provow, LLC and St. Johns County, FL. I hereby release any governmental, police, or other agency as custodian of such records, including all officers, employees, or related personnel, both individually and collectively, from any and all liability for damages of any type which may at any time result to me, my heirs, family, or associates, because of compliance with this authorization. I also understand that all information collected pertaining to this application may be considered public record. If a record of criminal convictions or other disqualifying information is found, the applicant may be given a copy of the criminal history report and asked if it is accurate prior to any final decision. If the applicant disagrees with the accuracy of the report, it will be up to him/her to provide any or all documentation to support his/her claim. PLEASE INITIAL: I hereby waive any right to assert that such investigation or request constitutes an invasion of my privacy. I recognize that such inquiries are in the interests of all persons, entities, and agencies involved, and I fully consent to such investigations. I, the undersigned, for myself, my heirs, executors, administrators, and representatives, do hereby remise, release and forever discharge and agree to indemnify and hold harmless Kathryn H Provow LLC, any involved background check vendor and/or licensed private investigator, St. Johns County, its directors, officers, employees, volunteers, agents, and representatives, as well as third parties, if any, that St. Johns County or its affiliates contact, directly or indirectly, regarding my application to, or future services with Kathryn H Provow LLC and St. Johns County, from and against any and all causes of actions, suits, liabilities, costs, debts, and sums of money, claims, and demands whatsoever, and any and all related attorneys fees, court costs, and other expenses resulting from the investigation of my background in connection with my application. I understand and agree that Kathryn H Provow LLC and St. Johns County may, at their sole discretion, decline to accept my application for, or participation in any work associated with any contract with or without cause. I ACKNOWLEDGE THAT I HAVE READ AND FULLY UNDERSTAND THE ABOVE CERTIFICATION / CONSENT FOR CRIMINAL BACKGROUND CHECK / AUTHORIZATION / WAIVER / RELEASE / INDEMNITY, AND THAT I ACCEPT AND SIGN THIS FORM VOLUNTARILY. I UNDERSTAND THAT THE ABOVE CERTIFICATION / CONSENT FOR CRIMINAL BACKGROUND CHECK / AUTHORIZATION / WAIVER SHALL CONTINUE EACH YEAR I PARTICIPATE IN ANY WORK ASSOCIATED WITH ANY CONTRACT WITH KATHRYN H PROVOW LLC AND ST. JOHNS COUNTY, AND SUCH WAIVER / RELEASE / INDEMNITY SHALL CONTINUE WITHOUT LIMITATION. Applicant s Full Legal Name Signature Date

5 Kathryn H Provow LLC St. Augustine Amphitheatre Farmer s Market Vendor Representative, Employee, Agent Release To the fullest extent permitted by law, I, the undersigned, shall indemnify and hold harmless Kathryn H Provow LLC, St. Augustine Amphitheater Farmer s Market and St. Johns County, Florida, and employees from and against liability, claims, damages, losses and expenses, including attorney s fees, arising out of or resulting from participation in the Market, provided that such liability, claims, damage, loss or expense is attributable to bodily injury, sickness, disease or death, or injury to or destruction to tangible property including loss of use resulting there from, but only to the extent caused in whole or in part by negligent acts or omissions of the vendor or anyone directly or indirectly employed by them or anyone for whose acts they may be liable, regardless of whether or not such liability, claim, damage, loss or expense is caused in part by a party indemnified hereunder. BUSINESS NAME PRINTED NAME DATE SIGNATURE