Common use of Date Authorized Signature Clause in Contracts

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. 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 L9L 1A7 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 L9L 1A7 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 2020 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. Appendix A Please visit the link below to download 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 Application Form: xxxx://xxx.xxxxxx.xx/departments/health/food_safety/specialEventsAppVendors .pdf Fee: $85.00 Receipt No. Appendix B 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 DATE 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: DATE Join Us for Canada Day 0000 Xxxxxx’s 150th Celebration Vendors The Township of Scugog is already thinking ahead to Canada Day 2017 which will xxxx Canada’s 150th birthday. As planning for this event is well underway we want to extend to you the opportunity to become involved and secure your spot as additional insured early as possible. Vendors who participate in Canada Day 2016 are eligible to take advantage of our early sign up discount for 2017. When vendors sign up for both Canada Day 2016 and 2017 a 15% discount will be applied to the booth fees for 2017. Please see the below early sign up pricing structure for any returning vendor for 2017. We look forward to having you be a part of Canada Day 2017! Fee Discount Total Fee (includes HST) Local Food Vendor License (– 10 x 10 $100 + HST $15.00 $96.05 Local Food Vendor – 20 x 10 $175 + HST $26.25 $168.09 Fee Discount Total Fee Food Vendor – 10 x 10 $150 + HST $22.50 $144.08 Food Vendor – 20 x 10 $250 + HST $37.50 $240.13 Fee Discount Total Fee Other Vendor – 10 x 10 $125 + HST $18.75 $120.06 Other Vendor – 20 x 10 $150 + HST $22.50 $144.08 Fee Discount Total Fee Not-for-profit – 10 x 10 NO CHARGE NO CHARGE Not-for-profit – 20 x 10 NO CHARGE NO CHARGE ** Fees only apply to the 2017 booth fees, if selling merchandise): $85 fee Refreshment Vehicle License (if selling food): TSSA gas/propane certificate Fire extinguisher certificate Durham Region health department approval $85 feethe vendor has signed up for 2016 the regular booth fees found on page 2 apply for 2016. YES, Please sign me up for Canada Day 2017 Vendor Name Contact(s) Name(s) Contact(s) Phone Number(s) Bus: Cell:

Date Authorized Signature. Appendix A Please visit the link below to download 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. Application Form: xxxx://xxx.xxxxxx.xx/departments/health/food_safety/specialEventsAppVendors .pdf 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 DATE 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 DATE 2018 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