Farmers Market Vendor Quote Form

January 11, 2013

Oregon Farmer’s Market Vendor Quote Form

Business/Account Name: *
Type:  *
Owner's Name: *
Product Location Address: *
Mailing Address: *
Phone Number: *
E-mail: *
Desired Effective Date: *
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Please list all products sold:  *
Are any products manufactured by others? *
If yes, please list products here and include where you obtain them from, i.e. direct from the manufacturer, from a wholesaler, from a local farm, etc.
What is your manufacturing process? Type of packaging, labeling, etc. *
What do you do to ensure the quality and safety of the products you are selling? *
If produce is sold, are all produce items washed before selling to remove soil and any chemical that may have been used on them?
When did you start this business? *
If new, do you have any related experience?
Do you have any other business operations conducted under the name insured listed above i.e. farm, nursery, etc? (If you are an individual, this would be any other operations regardless of the DBA) *
Total projected sales for the next 12 months:  *
If you are selling more than one thing, please provide a sales breakdown: (i.e. jewelry, crafts, hot food, jams, veggies, etc) *
Are you selling to stores, coffee shops, restaurants? If yes, what are your annual sales for each location: *
Prior insurance carrier, if any? *
Have you had any claims in the last 5 years? *
Have you had a policy declined, cancelled, or non-renewed in the past 3 years? *
Which markets will you be attending? *
Do you have a written contract with the operator of the market? *
Do you need to name the market as an additional insured on your policy? *
Is a formal safety program in operation? *
Any exposure to flammables, explosives, or chemicals?  *
If yes, please list exposures:

The following are questions specifically for vendors preparing food:

Are you licensed with the appropriate city/county to sell food?
Do you hold a valid Food Handlers Card?
Have you ever been cited by the Board of Health?
Please list the foods you prepare and sell:
If items are perishable, what kind of refrigeration is in place?
If items are cooked, how are they cooked/what is the method of cooking?
Are any items fully cooked and then warmed? If yes, please describe how warmed:
If not fully cooked, how do you make sure they are fully cooked on site?
What method is used to protect food from contamination while at the market? i.e. food wrap, sealed containers, etc.
Do you keep a fire extinguisher on the cart?
Do you serve any liquor, beer, or wine?
If yes, who is your liquor liability insurance through:
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