Application For License Form - City Of Kimmswick printable pdf download

Please print clearly

CITY OF KIMMSWICK

PRIVATE PROPERTY / MERCHANT LICENSEE

Application for License only

Event: _________________________ Date(s):__________

PROPERTY OWNERS NAME THAT YOU ARE RENTING FROM: _________________________________

APPLICANTS NAME: _______________________________________________________________________

BUSINESS NAME: __________________________________________________________________________

ADDRESS: _________________________________________________________________________________

CITY: _________________________________ STATE: _________ZIP: ___________

EMAIL ADDRESS: _______________________CELL PHONE: __________________________

SALES TAX NUMBER: _________________________________________

TYPE OF PRODUCT: List items you will be selling, homemade, resale etc. - (Food vendors list every food or

drink item you want to sell): No food vendor license will be issued less than 30 days prior to an event.

__________________________________________________________________________________________

*ALL FOOD PRODUCT AND SAMPLE VENDORS MUST HAVE A LICENSE THROUGH THE JEFFERSON COUNTY HEALTH

DEPARTMENT. CALL 636-797-3737, EXT. 2. Your Health Department License and proof of insurance of at least a two million dollar

policy with the Festival and City of Kimmswick named as additional insured must be provided to the city prior to your city license being

issued. This must be received 30 DAYS prior to the event. If you will be cooking food you will need to contact the Rock Community Fire

Protection District 636-296-2211 to see if you will require a permit. BOTH inspectors will be doing onsite inspections.

I hereby release the City of Kimmswick Missouri, private property owners, the Festival Committee and its individual members from responsibility for

damage to the arts/crafts/food or products displayed and my personal possessions as well as for any personal injury to myself. I am also responsible for

any injury that occurs to my booth. I also agree to indemnify and hold harmless said organizations and individuals for any damage or injury which may

result from the sale or display of my products. The City of Kimmswick Festival Committee reserves the right to accept or refuse any vendor license

application. The rules and regulations set by the City of Kimmswick are binding for all vendors. Fees for licenses are not refundable for any reason.

SIGNATURE OF APPLICANT: _____________________DATE: ____________________

COST: $20.00 License fee PER each 10X10 space. Number of spaces___________________

Make Checks Payable to:

Bring payment and application to City Hall or mail to:

CITY OF KIMMSWICK

City of Kimmswick

PO BOX 27, KIMMSWICK MO. 63053

PAYMENT DATE: ___________________ Check______ Money Order ___ Cash____ Receipt #___________

Please turn to other side to complete application SIGNATURE IS REQUIRED.

Application For License Form - City Of Kimmswick

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