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2. BUSINESS CONTACT INFORMATION
4. Buisiness Name*
6. Business Mailing Address*
8. City*
9. State*
10. Zip*
12. Business Website or Social Media Links*
13. Sample Menu
14. Business Logo*
16. Owner Name*
17. Phone*
18. Email*
20. Point of Contact Name (if different)
21. Phone
22. Email
24. REQUEST INFORMATION
26. Activity Type*

    1. Community Event
    2. Tournament/Race
    3. Sports Practice/Game
    4. Farmers Market
    5. Seasonal/Annual Park Vendor
    6. Other
27. Park Location*

    1. Fighting Creek Park
    2. Turner Park
    3. Aces Diamond
    4. Pocahontas Landmark Center
    5. All Parks
    6. Other
28. How Did You Hear About Us?*

    1. County Staff
    2. Coach/Instructor
    3. Website
    4. Social Media
    5. Word of Mouth
    6. Other
30. If there is a specific event your are applying for, list the event name here.
32. What is your truck size and power needs if applicable.*
34. FORMS
36. VDH Permit*
37. VDH Permit to Operate Mobile Food Vending Application
    VDH Permit Application
39. Business License*
40. Business License
    Powhatan County Business License

    A Powhatan County Business License is required for businesses grossing over $3,000 during a calendar year.

42. Certificate of Insurance

    A copy of a current insurance certificate is required by the County within two weeks of notice of application approval.  This certificate should identify Commercial General Liability insurance coverage to protect the participants. The County of Powhatan, Virginia, and its officers, employees, and volunteers shall be named as “additional insured” on the policy, and it shall be stated on the insurance certificate.      

44. APPLICATION & FEES

    Vendors are required to submit an online application. 

    Special event vendors are required to submit the vendor fee associated with the particular event. 

    Annual/seasonal vendors are responsible for providing Powhatan County Parks and Recreation Department (PCPRD) with a monthly statement of gross revenue from park sales and payment of $200 or 15% of the monthly net revenue, whichever is greater . Payment is due by the 15th of every month for the previous month.

    All mobile vending permits expire on December 31^st of the year issued.

46. Hold Harmless

    The user hereby agrees to indemnify and hold harmless Powhatan County, the Powhatan County Parks and Recreation Department, their officers, agents, all employees, and volunteers from any and all claims for bodily injury, and personal injury, and/or property damage, including cost of investigation, all expenses of litigation, including reasonable attorney fees, and the cost of appeals arising out of any claims or suits which result from errors, omissions, or negligent acts of the user, his agents or employees. Group is responsible for abiding by all PCPRD policies, rules and regulations.

48. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
50. Electronic Signature
Leave This Blank:


52. 1. Receive an email copy of this form.
53. Email address

    This field is not part of the form submission.

54. Submit

* indicates a required field