Date Authorized Signature. Appendix A Please visit the Region of Durham Health Department website to fill out your form and submit online. Please DO NOT send Health forms to the Township they MUST go to the Health Department directly. Appendix B Fee: $85.00 Receipt No. The Corporation of The Township of Scugog 000 Xxxxx Xxxxxx, Xxx 000 Xxxx Xxxxx, Xxxxxxx X0X 0X0 HAWKERS AND PEDDLERS SPECIAL EVENT APPLICATION NAME OF EVENT: TYPE OF BUSINESS: (Merchandise being vended) NAME OF BUSINESS: (if applicable) ADDRESS: (if other than applicant) PHONE NUMBER DAY: EVENING: NAME OF APPLICANT: ADDRESS: PHONE NUMBER (if other than above) DAY: EVENING: ATTACHMENTS Application Fee ($85.00) Proof of Insurance (Naming the Township of Scugog as additional insured) As owner and/or managing operator of the above, I do solemnly declare that the statements contained in this application are true, and that I am responsible for all individuals under my employment/supervision for the duration of any and all events covered by this application. DATE SIGNATURE OF APPLICANT Fee: $85.00 Receipt No. Appendix C The Corporation of The Township of Scugog 000 Xxxxx Xxxxxx, Xxx 000 Xxxx Xxxxx, Xxxxxxx X0X 0X0 REFRESHMENT VEHICLE LICENSE SPECIAL EVENT APPLICATION NAME OF EVENT: TYPE OF BUSINESS: (Merchandise being vended) NAME OF BUSINESS: (if applicable) ADDRESS: (if other than applicant) PHONE NUMBER DAY: EVENING: NAME OF APPLICANT: ADDRESS: PHONE NUMBER (if other than above) DAY: EVENING: ATTACHMENTS Application Fee ($85.00) Proof of Insurance (Naming the Township of Scugog as additional insured) Fire Extinguisher Health Department Approval Propane/Gas Certificate (If applicable) As owner and/or managing operator of the above, I do solemnly declare that the statements contained in this application are true, and that I am responsible for all individuals under my employment/supervision for the duration of any and all events covered by this application. DATE SIGNATURE OF APPLICANT 2019 VENDOR CHECKLIST Vendor Application: Completed & Attached: Contact info Fee Hydro outlets required Signed agreement Insurance Certificate of $5M: Township of Scugog as additional insured Vendor License (if selling merchandise): $85 fee Refreshment Vehicle License (if selling food): TSSA gas/propane certificate Fire extinguisher certificate Durham Region health department approval $85 fee
Date Authorized Signature. Manhattan Beach Unified School District
