Fillable St Martins Fair 2019 Transient Merchant Permit Application (City of Franklin)

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St Martins Fair 2019 Transient Merchant Permit Application (City of Franklin)

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9229 W Loomis Rd, Franklin WI 53132-9728

CITY CLERK 414-425-7500

Transient Merchant Permit Application

St Martins Fair 2019

September 1 & 2, 2019

 New  Renewal

 Labor Day Event (max.15 ft.) issued prior to 5:00pm Friday, August 30, 2019 $80.00

 Labor Day Event (30 ft.) issued prior to 5:00pm Friday, August 30, 2019 $160.00

 Issued at Fair (max.15 ft.) LATE: issued after 5:00pm Friday, August 30, 2019 $180.00

 Issued at Fair (30 ft.) LATE: issued after 5:00pm Friday, August 30, 2019 $260.00

 Nonintoxicating & Soda Water Beverages (with Labor Day Event fee) $5.00

Please Print All Information

1. Applicant Information

Applicant’s Full Name _______________________________________ Date of Birth___/___/___

Driver’s License Number ____________________________ State ____ Expiration ___/___/___

Please include a LEGIBLE copy of identification (i.e. Driver’s License)

Home Address ________________________________________________________________

City, State, Zip ________________________________________________________________

Phone _________________________ E-mail ________________________________________

Previous Address (Street or Route) ________________________________________________

If less than two years at present address

Previous City, State, Zip _________________________________________________________

2. Business/Corporation Information (if applicable)

Business Name________________________________________________________________

Corporation Name (if different from Business Name) ___________________________________

Business Address ______________________________________________________________

City, State, Zip ____________________________________ Phone ______________________

3. List ALL Criminal Convictions

Specify all offenses, giving dates and places of arrests and convictions ____________________

_____________________________________________________________________________

P:Shared/St Martins Fair/St Martins Fair 2019/2019-20 Application (Food.2)

4. Vehicle used for conducting business

Year ________ Make _____________ Model ______________ Sate/License # _____/__________

5. Type of products or services to be sold (be specific) ___________________________________

_________________________________________________________________________________

** If you are selling any type of food product, you MUST complete and return the

Temporary & Mobile Vendor Information form.

6. Wisconsin Seller’s Permit Number _________________________________________________

APPLICANT UNDERSTANDS AND AGREES THAT THIS PERMIT IS NOT TO INSURE NOR INDEMNIFY AND SHALL NOT BE CONSTRUED AS SUCH. APPLICANT

FURTHER AGREES THAT APPLICANT WILL INDEMNIFY AND HOLD HARMLESS THE

CITY OF FRANKLIN FOR ANY & ALL CLAIMS ARISING FROM THE SERVICE OR

GOODS PROVIDED UNDER THIS APPLICANT OR PERMIT

PPLICANT FURTHER UNDERSTANDS AND AGREES THAT APPLICANT APPOINTS THE MUNICIPAL CLERK OF THE CITY OF FRANKLIN “TO ACCEPT SERVICE

OF PROCESS IN ANY CIVIL ACTION BROUGHT AGAINST THE APPLICANT ARISING OUT OF ANY SALE OR SERVICE PERFORMED BY THE APPLICANT IN

CONNECTION WITH THE DIRECT SALES ACTIVITIES OF THE APPLICANT

, IN THE EVENT THAT THE APPLICANT CANNOT, AFTER REASONABLE EFFORT, BE

SERVED PERSONALLY

.” CODE OF THE CITY OF FRANKLIN §237.4.D.

SIGNATURE MUST BE NOTARIZED

_____________________ _________________________________________________________

DATE SIGNATURE OF APPLICANT

SUBSCRIBED AND SWORN TO BEFORE ME

THIS

________DAY OF _________________________________, 2019

_________________________________________________________

IGNATURE OF NOTARY PUBLIC

______________________, __________________________________

COUNTY OF STATE OF

__________________________

Y COMMISSION EXPIRES

P:Shared/St Martins Fair/St Martins Fair 2019/2019-20 Application (Food.2)

Please read, sign & return this sheet with application

City of Franklin

9229 W. Loomis Road

Franklin, WI 53132

(414)425-7500

COMBINATION FOOD AND PEDDLER PERMIT

GENERAL PERMIT REQUIREMENTS:

1. Permit will be issued to applicant, upon payment of required fees and upon signature of applicant to follow rules

governing operation at St. Martins Fair.

2. Permit fees cover the period beginning July 1

, ending June 30

, or any part thereof.

3. All operations that serve and/or sell food and non-beverage items, except for unprocessed food, are required to obtain

and display this permit. Unprocessed food includes farm products that are grown/produced by the farmer/seller on

the farmer/seller’s property (e.g. honey if unprocessed must be appropriately labeled and does not require a permit).

4. All property owners selling space to vendors are responsible to notify vendors of permit requirements and regulations

of St. Martins Fair.

5. All food and beer stands shall provide plastic liners for the trash barrels which they use, and they shall change the

liners as the barrels are filled. Liners are available at the Police trailer during the Fair.

6. No stakes shall be placed in any public asphalt of concrete walkway or street.

7. All food vendors must be located at least 50 feet away from port-a-johns and animals.

8. Selling and serving of home-baked, home-canned, or home-processed food is prohibited. Operations licensed by the

State of Wisconsin, must also possess and display the license(s) required for all other processed foods (e.g. taffy

maker), in addition to this permit.

9. All potentially hazardous foods must be mechanically refrigerated.

10. Soda permit is not included in this combination permit.

11. Operations not meeting permit standards are subject to closure by the Sanitarian upon inspection during the Fair.

12. Animals must be restrained or fenced, and kept reasonably away from public reach.

FOOD OPERATION

All food preparation and service will comply with the attached “Temporary Food Service Requirements”, which

includes all requirements for water supply.

FIRE PREVENTION & SAFETY

1. All food peddlers who are cooking food must have a currently certified ABC (2A10BC) and K fire extinguishers readily

available on site.

2. All open flame cooking must be done outside of either a tent or a canopy structure.

3. A tent or a canopy used in cooking shall be flame retardant and NFPA 701 verifiable.

4. Food peddlers must provide a minimum of 10 feet between tents or canopies used in cooking.

5. No cooking shall be done within 10 feet of a combustible wall or surface.

6. No cooking is permitted under a tent where patrons assemble or are seated.

7. Flammable liquids or gasses may not be stored within 10 feet of any ignition source.

8. Generators or any internal combustion power source must be separated by a minimum of 5 feet from any tent or

temporary membrane structure.

TESTIMONY OF READING:

I hereby state that I have read the above rules and agree to abide by them:

______________________________________ _______________________________________

Signature of Applicant Date

P:\Shared\St.Martins Fair\Agreement to Food Rules-Combination Food & Peddler Permit

7/1/2019 – 6/30/2020 Temporary & Mobile Food Vendor Information Sheet

Name of Food Stand:

Contact Person:

Address:

Certified Food Manager:

City:

State:

Zip:

Phone:

Name of Event:

Email:

Dates of Event:

FOOD PREPARATION AND MENU

• Menu: Only food items listed below will be approved to serve. Approval for any changes must be requested

at least two (2) business days before the event.

• Temperature Control: Any food found in the Danger Zone above 41°F and below 135°F will be

discarded.

No home prepared foods are allowed.

All foods must come from a commercial approved source or a licensed facility.

Any questions - Call the Franklin Health Department at (414) 425-9101

MENU: Complete the table below. List all foods, beverages, and condiments that will be served.

Use additional paper as needed.

Food Item

How

purchased at

store? (raw

or pre-

cooked)

Prepared in

Booth or

Approved

Kitchen?

Transport item

hot or cold?

What type of

equipment for

transport?

Cold holding

equipment

used at

event?

(41°F or

below)

Cooking/reheating

equipment used?

Final cook/reheat

temperature?

Hot holding

equipment used?

(135°F or above)

Example: Hamburger Raw Booth Cold/ Ice Chest Ice Chest Grill 155°F Grill/Steam Table

Where will food be purchased? (Examples: Walmart, Pick 'N Save, Reinhardt, etc.)

I, the applicant, understand that the:



City of Franklin field inspection report is required to operate in the City of Franklin.



Permit to operate may be suspended or revoked if serious conditions exist.



Inspection fees cannot be accepted by environmental health specialists in the field.



Inspection fees are not refundable.



Fees must be submitted 48 hours in advance to avoid the late fee.

I certify that I am familiar with the Temporary Food Service Requirements - as required in the Wisconsin Food

Code and the above establishment will be operated and maintained accordingly.

APPLICANT SIGNATURE

DATE

Are you currently licensed by the State of Wisconsin DATCP as a Mobile or

Temporary Food Vendor?

 Yes – Please fill out the sections below and return this form, along with payment, to the

City of Franklin Health Department (See address below).

 No – Please return this form to the City of Franklin Health Department (See address

below) and contact us at (414) 425-9101 to obtain a Local Temporary Food License

DATCP License Type:

License Number:

Name of Service Base:

Address:

*An original current DATCP license must be presented and available at all events.

7/1/2019 – 6/30/2020 Inspection Fee Schedule (1x fee per year)



Mobile Retail……………..$75



Temporary or Mobile Restaurant…………..$125



Late Fee (less than 48hrs. Prior to event)……………..$85

Not for profit organizations should discuss permitting requirements for exemption with the Environmental Health Specialist.

Submit the completed application and inspection fee in the form of check or money order payable to:

City of Franklin

Health Department

9229 W. Loomis Rd

Franklin, WI 53132

(414) 425-9101

In making this application, I understand this business is subject to the provisions of CHAPTER 40 of the Franklin Municipal Code. Effective

January 9, 2018. The City of Franklin will be charging a $25.00 fee for checks which are returned to us as uncollectible by our bank.

1. Legal Name

2. Business Name

3. Address (Street or Route)

4. City, State and Zip Code

5. Home Telephone Number ( )

Business Telephone Number ( )

6. Wisconsin Tax Account Number

7. Social Security Number

 8. FederalIdenticationNumber(FEIN)

9. Check one box indicating the type of activity you intend to engage in at this event:

X X X

X X

PART B: Operator Information: To be completed by the operator of the temporary event

1. Name and Address

2. Daytime Telephone Number ( )

 3. EmailAddress

4. Wisconsin Tax Account Number

If blank, check appropriate box:

This Form May Be Reproduced

Wisconsin Temporary Event Operator and Seller Information

S-240 (R. 12-14)

Information on this form is required under sec. 73.03(38), Wis. Stats.

Instructions on reverse side.

PART A: Event Information: To be completed by the operator of the temporary event

 1. NameofTemporaryEvent

 2. Date(s)ofTemporaryEvent

 3. LocationofTemporaryEvent(e.g.,Venue,City)

Other–Explain:

No Taxable Sales ExemptunderOccasionalSalesRule ExemptNonprotOrganization

Direct Sellers, Company Name

SellingExemptMerchandiseorService

Display Only

ExemptunderOccasionalSalesRule

NonprotOrganization

I declare that the information on this form is true and correct to the best of my knowledge and belief and that I am authorized to sign

this form.

Print Name:

Information about temporary events, including forms, instructions and Common Questions can be found on the Department of Revenue’s

website at revenue.wi.gov/html/temevent.html. If you have additional questions, please contact the Department of Revenue by

email at DORBusinessTax@revenue.wi.gov

or telephone at (608) 266-2776. See reverse side for submission instructions.

PART C: Seller Infor mation: To be completed by seller and given to event operator on or before the rst day of event.

SellingTaxableMerchandiseorService

THIS IS NOT AN APPLICATION FOR A WISCONSIN TAX ACCOUNT – SEE INSTRUCTIONS

Signature: Date:

X X

X XX

Do not email event reports to maintain condentiality of seller information

Instructions

TAB through to navigate. Use mouse to check

applicable boxes, press spacebar, or press Enter.

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ST. MARTINS FAIR

SEPTEMBER 1ST & SEPTEMBER 2ND, 2019

APPRX 11400 BLK ST.MARTINS RD, FRANKLIN

CITY OF FRANKLIN

9229 W LOOMIS RD., FRANKLIN, WI 53132

414

425-7500

swesolowski@franklinwi.gov

✔

MUNICIPAL CORPORATION

Instructions for Completing Operator and Seller Information

EVENT OPERATOR:

An “operator” is defined as a person or entity (such as an

individual, association, partnership, corporation, or non-

profit organization) that arranges, organizes, promotes,

or sponsors an event. An operator may also be referred

to as an organizer, exhibitor, or decorator. An operator

may or may not be the owner of the property or premises

where the event takes place. An operator may also be a

seller at the event.

Note: A Wisconsin tax account number (formerly

seller’s permit) is required if selling taxable merchandise

or services. Admission fees are subject to sales tax in

Wisconsin.

Step 1: Complete Parts A and B.

Step 2: Provide a copy of Wisconsin Temporary Event

Operator and Seller Information (Form S-240) with Parts A

and B completed to each seller participating in your event.

To obtain additional copies of Form S-240 go to the

Department of Revenue’s website at revenue.wi.gov/

forms/sales/index.html. If you prefer, you may use the

fill-in form available from the same website.

Step 3: Submission–EventOperator.

Submit compiled vendor information to the department

as soon as possible but no later than 10 days from event

closing using one of the following methods:

• Electronic Reporting: If you have all the required

sellers’ information, use the Excel spreadsheet

provided at revenue.wi.gov/html/temevent.html.(Excel

viewer is available.) Fill in the information for all

sellers participating at the event and submit using the

department’ssecure le transmission application at

revenue.wi.gov/eserv/wteptran.htmlorbyU.S.Mail.Do

not email event reports to maintain condentiality

of seller information.

• Paper Reporting:Mail completedFormsS‑240ora

printed version of spreadsheet to:

 TemporaryEventsProgram

Wisconsin Department of Revenue

PO Box 8910

 MadisonWI53708‑8910

SELLER:

A “seller” is defined as a person or entity involved with

selling merchandise or providing taxable services at a

temporary event. A seller may also be referred to as a

vendor, exhibitor, or booth owner.

Important: This form is not an application for a

Wisconsin Tax Account Number. If you do not already

have a tax account number but are required to, you

will need to apply for one directly with the Department

of Revenue prior to the event. You can apply online or

download an application, Application for Business Tax

Registration (Form BTR-101) on the department’s website,

revenue.wi.gov/forms/sales/index.html. Not all sellers

are required to obtain a Wisconsin tax account number.

Some of the reasons a seller may not need a tax account

number are:

• The seller only sells tax-exempt items, such as

vegetables for home consumption.

• The seller is only displaying at the event, no onsite

orders are being taken, and taxable merchandise is not

later shipped into Wisconsin.

• The seller qualifies for the occasional sale exemption.

(See Publication 228, Temporary Events.)

If you have questions regarding applying for a Wisconsin

tax account number, contact any Department of Revenue

office, visit our website, or call (608) 266-2776.

Step 1: Complete Part C (event operator should com-

plete Parts A and B).

Line1: Enteryourindividual,partnership,association,or

corporate name.

Line2: Enteryourbusinessname,ifdifferent.

Line3: Entertheaddressofthephysicallocationofyour

business. If different, also provide your mailing

address.

Line6: Enteryour15‑digitWisconsintaxaccountnumber.

You can find this number on your Form ST-12.

This number is not your 6-digit seller’s permit

number issued to you prior to December 31, 2002.

Lines7&8:Enterthelastfourdigitsofyoursocialsecurity

number and/or federal employer identification

number. This is required under sec. 73.03(38), Wis.

Stats., if you do not provide a tax account number.

Step 2: Submit completed form to event operator on or

before the first day of the event.

Revenue Field Agents attend temporary events

to verify registration of sellers. Sellers must have

evidence of their Wisconsin tax account number

at the event.

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