Fillable APPLICATION FOR SPECIAL EVENT / VENDOR LICENSE A (The Tulalip Tribes)

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APPLICATION FOR SPECIAL EVENT / VENDOR LICENSE A (The Tulalip Tribes)

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APPLICATION FOR SPECIAL EVENT / VENDOR LICENSE
Please type or print in dark ink
BLANKSPACESARENOTPERMITTED.IFANYITEMISNOTAPPLICABLE,ORNOINFORMATIONIS
AVAILABLE,THESPACEMUSTBEMARKEDTOINDICATETHAT.INCOMPLETEAND/ORILLEGIBLE
APPLICATIONSWILLBERETURNEDTOAPPLICANT.
The Tulalip Tribes of Washington
Communityy Dev
Development Department
TAX X & LICENSING DIVISION
6406 Marine DR NW
Tulalip, WA 98271 WA 98271
Telephone: (360) 716-4204
PAYMENT SUMMARY - A PAYMENT SUMMARY - A
pp
lications received without
p
a
y
ment in
f
ull will not be acce
p
ted. FEE
APPLICATION FEE
$ 10.00
Enclose payment for total amount due, including application and applicable penalty fees. Accepted
forms of payment are cash, check, and money order made payable to The Tulalip Tribes / TLD.
License fees are not pro-rated and are nonrefundable.
TOTAL AMOUNT PAID
$
BUSINESS STRUCTURE
SOLE PROPRIETOR INDIVIDUAL - No employees DOMESTIC CORPORATION
FOREIGN CORPORATION PARTNERSHIP LIMITED LIABILITY PARTNERSHIP
LIMITED LIABILITY COMPANY COMMERCIAL FUNDRAISER OTHER _____________________
STATUS OF
ORGANIZATION
AND TYPE OF
ENTITY
Partnership, Corporate
Officers, Managers and/or
Members information
Is business classified as a Nonprofit or Charitable Organization for educational, religious, or charitable purpose (ex: (C) (3) non-profit status or equivalent)?
YES NO If Yes, attach proof of status (Statement from IRS or Secretary of State or equivalent)
CHARITABLE ORGANIZATION CHARITABLE TRUST NOT FOR PROFIT CORPORATION
EDUCATIONAL ORGANIZATION RELIGIOUS ORGANIZATION
BUSINESS / VENDOR INFORMATION – GENERAL
Vendor / Trade Name
Website:
www.
Business Address (Primary Physical Location if any or business mailing address)
City State Zip County
Business Telephone Number
( ) -
Alt or Toll Free Number
( ) -
FAX Number
( ) -
Does business maintain an office
or store located within the
exterior boundaries of the Tulalip
Res rvatio e n?
YES NO
Is bu
siness located at a private
resident (i ho e office)?
.e. m
YES NO
Indicate if business is Full
or Part Tim : e
Part Full
Owner Name(s)
Describe in detail the nature of business, principle products sold, and services provided on the Tulalip Reservation. Indicate if sales are retail or wholesale and if products are manufactured on the
reservation:
Estimated Gross Annual Income for services provided on the Tulalip Indian
Reservation for current year:
$
Is this an Indian Owned Business?
YES NO If Yes; Percentage Indian Owned: %
Tribal Enrollment # Name of Federall
y
Reco
g
nized Tribe: ATTACH PROOF
Do your business dealings and transactions include providing care or services (non-retail) children under the age of 18? YES NO
If Yes, please explain:
EVENT INFORMATION
Event Name
Event Hos
t or Sponsor Name(s)
Special Events Location (Street or Route, City, State, Zip – Tulalip Location Only)
Total number of days vendor
will work event:
ALL
OTHER ________
If other, specify dates:
____________________
____________________
Special Event Schedule- If dates of event are not consecutive please provide additional event schedule details in the space provided below (ex: Every Tuesday
and Friday during the month of April; 9 Total Days)
BEGIN / END DATES: ______________ to ______________ OPEN / CLOSE TIMES: ________ to ________ # DAYS TOTAL: _____
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
Briefly describe the type and purpose of Special Event:
List any individuals other than business owner that are employed to assist you/ your business for this event:
_______________________________ _______________________________ _______________________________ _______________________________
LIC NUMBER
OFFICIAL USE ONLY
FOOD LIC NUMBER APPLICABLE YEAR
CHECK / MONEY ORDER # RECEIPT NUMBER
A
B
C
D
MISCELANEOUS
WA State Unified Business Identification Number
(WA UBI #)
Federa
l Employer I.D. Number (FEIN)
North
American Industry Classification System
Number (NAICS)
Reseller’s Permit Number
Indian
Traders License Number
AFFILIATE(S),
LICENSES, ETC.
Is this a Nonprofit Organization for educational, religious, or charitable purpose? YES NO
If Yes, attach statement from Internal Revenue Service- (C) (3) non-profit status or equivalent
Tulalip licenses held currently and/or previous by applicant, business partners, and/or affiliates. Indicate business name, license number, business type, and owner(s):
Does this business possess a current vendor license issued by the Tulalip Casino/Gaming or lease agreement (special operators license) with Quil Ceda Village/Business Park? YES NO
If Yes, Gaming (Vendor) License
# *If yes, attach copy of Quil Ceda Village Special Operators License
Is business affiliated with any other business(es), including subsidiaries? YES NO If yes, please explain affiliation (business relationship) – attach additional sheet if necessary:
ALCOHOL / LIQUOR AND TOBACCO (Title 10 #10.35 & Title 12 #12.10)
Do your business operations include manufacturing, distribution, and/or sale of alcohol or tobacco
products?
YES NO If yes, attach copies of document(s)
FOOD AND BEVERAGE (Title 11 #11.20)
Doe your usiness prepare food and/or beverage goods for customer consumption? s b
YES NO If yes, attach copies of document(s)
TULALIP TRIBAL EMPLOYMENT RIGHTS ORGANIZATION
Does business have a Tulalip TERO Compliance Contract?
YES NO No do intend to enter into a Tulalip TERO Compliance Contract? If , YES NO
Is B listed on the Tulalip TERO Native Owned Business Registry? usiness YES NO
A DDITIONAL INFORMATION
TERO COMPLIANCE PLAN TERO (360) 716-4747
Tulalip TERO Title 9 #9.05: TERO is the Equal Employment Opportunity Commission Representative (EEOC) on the Tulalip reservation. Tulalip
TERO laws and ordinances enforce specific requirements upon businesses, contractors, and subcontractors doing business within the exterior
boundaries of the Tulalip Reservation including regulating their employment practices and obligating them to provide preference in recruiting,
hiring, training and promotions to certified Native Americans.
FOOD & BEVERAGE, LIQUOR, TOBACCO, TRANSIENT ACCOMMODATIONS, AND FIREWORKS LICENSE REQUIREMENTS
Tulalip Tribes Cigarette Tax Title 12 #10.12: LICENSE(S) REQUIRED- At this time, Cigarette (Tobacco) Licenses are required only for Tribal
Owned Businesses operating or providing services which includes the sale of tobacco products on the Tulalip Reservation.
Tulalip Tribes Liquor License Title 10 #10.35 and Tulalip Liquor Regulations: LIQUOR LICENSE(S) REQUIRED
Tulalip Fireworks Code Title 10 #10.25: WHOLESALE AND RETAIL LICENSE(S) REQUIRED- Sale of retail fireworks in Tulalip
is restricted to enrolled members of the Tulalip Tribes of WA; sale of wholesale fireworks is unrestricted.
Tulalip Tribes Food Service Sanitation Title 11 #11.20: PERMIT REQUIRED- Food and beverage related businesses show proof of Tribal and/or
State health inspection certificate, food permit, and/or food handler card.
Tulalip Tribes Transient Accommodation Title 10 #10.40: LICENSE REQUIRED
INDIAN TRADERS LICENSE
For information pertaining to Indian Trader’s Licenses, please visit/ contact the Bureau of Indian Affairs, Puget Sound Agency at:
2707 Colby Avenue, Suite 1101, Everett, WA 98201 - (425) 258-2651
SUPPLEMENTARY DOCUMENT REQUIREMENTS
The Tax & Licensing Division may require proof of insurance, tribal enrollment, certification, permits, contracts, other licensure (local, state, county,
etc.), vehicle registration, criminal background investigation, and additional information and/or documentation as defined in Tulalip Business License
Title 10 #10.10
INCOMPLETE AND ILLEGIBLE FORMS WILL NOT BE ACCEPTED / PROCESSED
Incomplete and/or illegible applications and/or failure to remit fee or required supplemental documents are not accepted and may result in penalty
fees.
SIGNATURE REQUIRED (Sole proprietor, partner(s), corporate officer(s), limited liability manager(s), or member(s))
Your signature attests to the accuracy of the information provided and that your business will comply with all applicable Tribal and Local Laws
BY SIGNING BELOW, I UNDERSTAND AND AGREE TO THE FOLLOWING:
I DECLARE THAT I HAVE EXAMINED THIS APPLICATION AND THE INFORMATION CONTAINED HEREIN, AND TO THE BEST OF MY KNOWLEDGE
AND BELIEF, IT IS TRUE AND CORRECT. I SWEAR OR AFFIRM THAT I WILL COMPLY WITH ALL TRIBAL LAWS APPLICABLE TO MY BUSINESS
AND CONSENT TO THE JURISDICTION OF THE TRIBAL COURT OF THE TULALIP TRIBES AND SERVICE OF PROCESS IN MATTERS ARISING
FROM THE CONDUCT OF BUSINESS.
Signature
X
Printed Name Title Date
Signature
X
Printed Name Title
Date
Application prepared by (Indicate if prepared by other than authorized owner, officer, manager, or
member)
Telephone Number
(
)
-
Signature of Preparer
X
Title Date
E
F
G
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APPLICATION FOR SPECIAL EVENT VENDOR LICENSE A (The Tulalip Tribes)

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Completed 20 July 2020

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