Vendor Registration Form

Event Vendor Registration

Vendor registration information for transient vendor compliance.

I will use rented space at this event for the sale of:

Handmade Items

New Items

Food Truck - Mobile Food Vendor

Vendor Business or DBA Name:(Required)

Vendor Address:(Required)

Street Address Address Line 2 City State ZIP Code

Name of Person Completing Form:(Required)

First Last

Email(Required)

Enter Email Confirm Email

Phone(Required)

Transient Vendor License Number:(Required)

Types of Goods Sold:(Required)

Select if you are an Indepedent Direct Sales Representative (i.e. Tupperware, Scentsy, Mary Kay, ColorStreet, etc...)

Yes, I am a direct sales representative.

Upload Copy of Transient Vendor's License OR Mobile Food or Temporary Mobile Food License if a food truck vendor AND Certificate of Liability Insurance.(Required)

Drop files here or

Max. file size: 256 MB.

Consent(Required)

I agree to the release from Liability & Indemnity Agreement

In consideration of the LaGrange Lions Park permitting me to enter upon and to use it's property for the purpose of participating in: Jammin’ with Jack Spring Food Fest & Concert on May 20, 2023 from 12;30-8:00pm
I/We do hereby forever release and covenant to HOLD HARMLESS the LaGrange Lions and the Committee to Elect Hall for Sheriff, successors, departments, officers, employees, servants and agents of and from any and all actions, causes of actions, claims, demands, damages, costs, loss of services, expenses and compensation on account of, or in any way growing out of, directly or indirectly, all known and unknown personal injuries or property damages which I/We may now or hereafter result from any act or omission related to my participation in the aforementioned.
I/we shall provide general liability insurance, including products and completed operations with limits of not less than One Million Dollars ($1,000,000.) per occurrence and Two Million Dollars ($2,000,000.) aggregate limit per policy period. All vendors shall provide a certificate of insurance naming the Committee to Elect Jack Hall for Sheriff, its officers, members and agents as Additional Insured for all required coverage prior to commencing any activity for, with or on behalf of the Jammin’ with Jack event. With the signing of this contract the Committee to Elect Jack Hall for Sheriff including its officers, members and agents will be held harmless against debts and business expenses and obligations incurred including any and all liability claims by reason of any accidents, injuries, damages or sickness that may occur during the term and performance of this contract and against all fines, penalties and loss incurred for by reason of the violation of county, state or Federal laws. All vendors serving food including any non-profit local organization will acquire the proper health department certificates or licenses required to comply with local health department regulations governing the serving of food items for public consumption. Food vendor licenses may be obtained from the Lorain County General Health District, 9880 South Murray Ridge Rd., Elyria, Ohio 44035, and Phone 440-322-6267. contact@LorainCountyHealth.com
Furthermore, I/We hereby agree to protect the LaGrange Lions and the Committee to Elect Hall for Sheriff and it's successors, departments, officers, employees, servants, and agents against any and all claims for damages, compensation or otherwise on the part of said minor growing out of or resulting from injury resulting from My/Our participation in programs of the LaGrange Lions and the Committee to Elect Hall for Sheriff INDEMNIFY, reimburse or make good to the LaGrange Lions and the Committee to Elect Hall for Sheriff or it's successors, departments, officers, employees, servants and agents any loss or damage or cost, including attorney's fees, the LaGrange Lions and the Committee to Elect Hall for Sheriff may have to pay of any litigation that arise from My/Our participation in the Jammin’ with Jack Spring Food Fest & Concert.

Vendor Space Type Selection(Required)

Select type of vendor space required.

Total Vendor Spaces Required:

Please enter a number from 1 to 10.

If additional adjacent spaces are needed, please select the total spaces required.

Total

Select Payment Type:(Required)

Credit Card

Check

Credit Card Payment

Card Details

Cardholder Name

Check Payment

Checks should be made payable to the Committee to Elect Hall for Sheriff. Checks should be sent to P.O. Box 786, Columbia Station, Ohio 44028. Checks should be from personal accounts or accounts from sole proprietor business accounts. Checks from partnerships or Limited Liability Companies which have partners of the LLC are required to have an attestation from all partners in which they support the campaign donation being drawn upon their partnership or LLC bank account. The committee cannot accept donations from foreign nationals. An appropriate address of the donor must accompany the check.

Event Vendor Registration