Registration – Food Vendor | The Bluemont Fair

Business Name *

Contact Name *

Street Address *

Apartment, suite, etc

City *

State *

ZIP Code *

Cell Number *

Home Phone Number

Email Address *

Website

Set Up Date *

Set Up Time *

Hours

Minutes

Vendor Category *Food ConcessionaireSpecialty FoodsPlease see instructions for definitions and fees.

Service Type *Tent and tableFood Truck with or without tableOther

Service Type - Other

Equipment - Please Check All That Apply *

Generator (Must Be Quiet)Tables And Chair For CustomersOpen-air GrillOther Cooking Appliance

Equipment - Other Cooking Appliance

Upload Menu Items including Drinks

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Please list or attach a separate page. Also indicate any items that consist primarily of foods grown or raised within a 125-mile radius of Loudoun County.

Preferred Locations - Please list twoIn most circumstances returning vendors will be located in the same space that they were in last year (WIWLY). I will notify you personally if a change in location is anticipated. The fair reserves the right to locate vendors at their discretion. However, requests for particular locations will be considered.

Health Department Fees and Regulations

Please read the enclosed Temporary Food Guidelines and Information Packet. All vendors serving prepared foods are required by the county to be in compliance with their regulations and submit a Temporary Food Permit Application. Specialty Food vendors selling items that are regulated by the Virginia Department of Agriculture or the United States Department of Agriculture or those specifically exempted from VDACS inspection are required to submit a notice to participate. Sampling of any items that are prepared with a utensil such as a knife or spoon or the use of non-bottled water still require adherence to the hygiene practices outlined in the Temporary Food Guidelines Information Packet.

Proof of PaymentCopy of receipt showing payment to a VA county or city health department in the 2024 calendar year.Copy of license for mobile food or permanent restaurant operation in VA.Check for $40.00 made payable to VDH if you do not have a permit.All applications must include ONE of the above

Upload Proof of Payment *

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Do not send your Health Department Temporary Food Application and Proof of Payment to Leesburg. Enclose them with your Bluemont Fair Food Vendor Application, as the fair must submit them as a group.

Liability Insurance

Please ask your insurance provider for a Certificate of Liability Insurance (COI), showing proof of your coverage for our event. Coverage should be a minimum of $1M per occurrence/$2M aggregate. It should list the Bluemont Citizens Association as Certificate Holder, at the following address: Bluemont Citizens Association PO Box 217 Bluemont, VA 20135

Vendor Fees

Please read the information sheet to determine if you have calculated the fee appropriately.

What is the total length (in feet) of your mobile food unit (to include tongue) or your tent *

All spaces are 12’ x12’. If your unit/tent is longer than 12’ you must request the appropriate number of extra spaces.

Number of Spaces *All spaces are 12'x12'. If your unit/tent is longer then 12' you must request the appropriate number of extra spaces.

Food Concessionaire

Specialty Food