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2. Business Name:*
4. Primary Contact:*
6. Street Address:*
8. City:*
9. State:*
10. Zip Code:*
12. Home Phone:*
13. Mobile Phone:*
15. Email Address:*
17. Website or Facebook Link:
19. Please list names of employees, partners or family members who will be selling at the market:*
21. What is your preferred method of communication?*

    1. E-mail
    2. Phone
23. What products does your business plan to sell?*

    (Please list all products, and be specific. If you plan to resell any products, please provide names and contact information for all farms or businesses where you will be purchasing these products).

25. Identify the primary product category that best represents what your business will sell:*

    1. Produce
    2. Meat
    3. Seafood
    4. Plants/Flowers
    5. Eggs
    6. Crafts/Art
    7. Dairy
    8. Value-Added Food
    9. Prepared Food
    10. Wine/Hard Cider
    11. Other
26. Check all boxes below that describe your operation and production practices: (*By USDA definition)*

    1. Certified Organic*
    2. Grass Fed* or Grass Finished
    3. Using Organic Ingredients*
    4. Certified Naturally Grown
    5. Free-Range/Pastured
    6. Cottage Food
    7. MAEAP
    8. No Added Hormones, Antibiotics
    9. Other
28. Tell us about your business:*

    Please type us a short biography/story (5 sentences), such as your mission, production practices, history, etc. that we can place on the website/Facebook to promote your business.

30. Are you interested in participating in Special Events?*

    1. Yes
    2. No
31. Are you interested in participating in our food assistance programs? Please check all that apply. Learn more at mypark.portagemi.gov.*

    1. Supplemental Nutrition Assistant Program (SNAP/EBT)
    2. Double Up Food Bucks
    3. WIC Project FRESH
    4. Senior Project FRESH
    5. Eat Smart, Live Strong
    6. NA
33. Please check the dates you would like to apply to participate in at the market below:*

    1. May 7
    2. May 14
    3. May 21
    4. May 28
    5. June 4
    6. June 11
    7. June 18
    8. June 25
    9. July 2
    10. July 9
    11. July 16
    12. July 23

    1. July 30
    2. August 6
    3. August 13
    4. August 20
    5. August 27
    6. September 3
    7. September 10
    8. September 17
    9. September 24
    10. October 1
    11. October 8
    12. October 15
35. Select each line item to which you agree; leave blank those to which you do not agree or (not applicable to your farm or business):*

    1. I have read and understand the Vendor Rules and Guidelines and agree that I and my trained business employees will adhere to them, knowing that failure to do so may result in forfeiture of my space.
    2. I plan to resell products (up to 25% of my offerings) from other local growers or businesses to supplement the offerings from my farm or business. I am providing a list of those farms and/or business.
    3. I will provide copies of all applicable businesses and food licenses with this application.
    4. My farm/business has liability insurance for the Portage Farmers Market. I have attached a copy of my insurance with this application. (This is required for hot-and-ready and prepared food vendors).
    5. My farm/business does not have liability insurance for the Portage Farmers Market. I will sign a copy of the "Release of Liability" agreement below upon submitting my application.
    6. I am willing to complete a vendor profile, provide anonymous weekly sales data, and complete a year-end survey for evaluation purposes to provide valuable data and feedback for the market.
    7. I would like to provide samples of my product at the market.
37. Please list the product(s) to be sampled:
39. A Non-Refundable deposit of $75.00 for seasonal vendors ONLY is due with this application. This deposit will be applied towards your season fee should your application be approved. If your application is not approved the $75 deposit will be refunded. The remaining seasonal balance is due by April 28, 2023.
43. Release of Liability

    I, the undersigned, consent to participate in the Portage Farmer’s Market or being the parent or legal guardian of such a participant. In consideration of my or another’s participation in the Portage Farmer’s Market hereby for myself, and any participant for who I am a parent or legal guardian, release, discharge, waive and hold harmless the City of Portage, its officers, agents, representatives and employees, from and against any and all liability, actions, causes of actions, claims known or unknown now existing or that may arise in the future arising out of or connected in any way from participation in the Portage Farmer’s Market even though liability may arise out of negligence or carelessness on the part of the persons or entities mentioned above.  I also hereby for myself or any participant for who I am a parent or legal guardian, waive, release and discharge any and all claims for damages for death, personal injury or property damage which may subsequently accrue as a result of participation in the Portage Farmer’s Market.  I acknowledge that the City of Portage is not to be held responsible for damaged or lost items submitted as participation in the Portage Farmer’s Market.

    I understand and acknowledge that accidents may occur during an event or activity which may result in personal injuries and/or property damage as a consequence thereof.  Knowing the risks involved, I nevertheless, agree to assume those risks and to release and hold harmless all of those persons and entities mentioned above who, through negligence or carelessness, might otherwise be liable to me, or my heirs or assigns, for damages.

     I, further understand the hazards of the novel coronavirus (COVID-19) and its variants, and am familiar with the Centers for Disease Control (CDC) and prevention guidelines regarding this disease. I acknowledge and understand that the circumstances regarding this disease are changing from day to day and that, accordingly, the CDC guidelines are regularly modified and updated and I accept full responsibility for familiarizing myself with the most recent updates. I will adhere to CDC guidelines, and regardless of the risks associated with COVID-19 and its variants, which I readily acknowledge, I hereby willingly choose to participate in the City of Portage activities. I fully assume the risk of illness or death related to this disease arising from my being on the premises and participating in the activities.

     It is further understood and agreed that this waiver of release is an assumption of risk and is to be binding on my heirs and assigns.   I agree to be fully responsible for any injury or damage to any non-participant who may accompany me and hold the City, its officers, agents, representatives and employees harmless from any liability or actions which may result.  I further agree to abide by and accept all of the rules conditions and regulations of the City of Portage, which are a condition of my participation in this program.

45. I have read and agree to the Release of Liability*

    1. Yes
    2. No
49. Publicity Release

    The City of Portage has my permission to use my photo/image, voice or an item created by myself including photos, drawings/illustrations, or other submitted item for promotional or educational purposes only including exhibition displays.  The City of Portage will receive the right to reproduce, at its own expense, images including, printed materials, online publications, news releases, videos, advertisements, media sites, website and social media outlets. I also provide permission for my name to be used in conjunction with the photos, videos or exhibition items.  I also understand that no royalty, fee or other compensation shall become payable to me, by reason of such use.  I hereby release the City of Portage and its agents and assigns from any and any claims which may arise out of or are in any way connected with such use. 

51. I have read and agree to the Publicity Release*

    1. Yes
    2. No
55. Certificate of Liability Insurance

    Required 30-days prior to attending the Portage Farmers Market; a copy of your organization's certificate of General Liability Insurance policy in the amount of $1,000,000 per occurrence and Motor Vehicle Liability Insurance policy in the amount of $1,000,000 per occurrence combined single limit for Bodily Injury and Property Damage. Coverage shall include all owned vehicles, non-owned and hired vehicles. All coverage as described above shall be endorsed to reflect the following as Additional Insured: "City of Portage, its elected or appointed officials, all employees, volunteers, all boards, commissions, and/or board members, including employees and volunteers thereof (except Workers Compensation)". It is understood and agreed by naming the City of Portage as additional insured, coverage afforded is considered to be primary and any other insurance the City of Portage may have in effect shall be considered secondary and or excess. Named organization must require proof of insurance coverage, as stated above, from all sub-contractors and vendors.

     All policies, as described above, shall include an endorsement stating that it is understood and agreed thirty (30) days, Ten (10) days for non-payment of premium, Advanced Written Notice of Cancellation, Non-Renewal, Reduction, and/or Material Change shall be send to the City of Portage Purchasing Manager, 320 Library Lane, Portage, MI 49002.

57. I have read and agree to the Certificate of Liability Insurance*

    1. Yes
    2. No
58. Option to upload licensing HERE
62. Electronic Signature Agreement:*

    By signing below, you certify that the information provided on this application is true and accurate and pledge that, as a vendor of the Portage Farmers Market, you will abide by the 2023 Portage Farmers Market Rules and Guidelines.

    1. I agree.
64. Electronic Vendor Signature:*
65. Date:*
    Date:
67. Electronic Vendor Signature Agreement:*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date. 

    1. I agree.
71. For Portage Parks and Recreation Staff ONLY
73. Electronic Market Manager Signature
74. Date:
    Date:
76. Electronic Parks Director Signature
77. Date:
    Date:
Leave This Blank:


79. 1. Receive an email copy of this form.
80. Email address

    This field is not part of the form submission.

81. Submit Submit and Print

* indicates a required field