July 29th 2017
Everett Forest Park (802 E. Mukilteo Blvd.)
VENDOR/BOOTH SPACE APPLICATION FORM
When completing your application, please be specific about the type of merchandise you wish to sell, the services you provide and your non-profit status.
1. ALL PAYMENTS MUST BE INCLUDED WITH YOUR APPLICATION
(PAYMENT OPTIONS: MONEY ORDER OR CASHIER CHECK)
2. APPLICATION AND FEE MUST BE RECEIVED NO LATER THAN SATURDAY JULY 1st 2016.
The Snohomish County Black Heritage Committee retains the right to accept or deny vendor applicants, based upon the service or product
they are offering. To ensure our event maintains integrity and a high quality status, all vendors will be evaluated for their customer service
and quality of their product. Vendor spaces are processed and secured on a first secured basis (i. e. Vendor Application and Fee receipt
confirmed by the Nubian Jam Committee). If you have a food specialty, please submit your application ASAP to secure approval of your dish
– variety is very important so we would prefer no duplicate food vendors (i.e. if KFC secures a booth and Churches requests a booth space,
Churches must come to Board meeting to request approval). We, the Nubian Jam Committee, reserve the right to approve or deny any Vendor
- all decisions made on case by case basis.
FOOD VENDOR REQUIREMENTS: Food Items are any items which can be consumed by mouth
All Permits and Insurance Proof are required 30 days prior to the event – Friday June 30th 2017
The following must be present on the day of the event - Saturday July 29th 2017
NO EXCEPTIONS/ NO REFUNDS
* Food item(s) approved by committee
* All Required Food Permits from Snohomish County Health Department
* FREE Everett Fire District Permit
* All Equipment required by both the Health Dept and Fire Dist. to pass inspection
* Proof of Liability Insurance
* Recycling Containers
* Fire Extinguisher
* Floor Coverings
* 25’ Electrical Cord (Vendors are responsible for providing extension cords/ additional power outlets)
NON FOOD VENDOR using Electricity REQUIREMENTS:
* Free Everett Fire District Permit
* Fire Extinguisher
* Floor Coverings
* 25’ Electrical Cord (Vendors are responsible for providing extension cords/ additional power outlets)
***ALL Vendors are responsible for signs, tents, chairs, tables and supplies needed for your individual space. There will be a rental charge of $25.00 per item for
use of extension cords, chairs and tables per item provided by Nubian Jam Committee – When asking for additional assistance, be sure to have the fee (money)
ready to give when items are presented. Otherwise assistance will not be given – PLEASE COME PREPARED WITH EVERYTHING YOU NEED TO HAVE A
SUCCESSFUL FUN FILLED DAY … THE JAM COMMITTEE IS NOT REQUIRED TO PROVIDE SUPPLIES FOR ANY VENDORS***
PLEASE CONTACT:
SNOHOMISH HEALTH DISTRICT (425-339-5250) or http://www.snohd.org/Food/Temporary-Food-Booths WITH FOOD REQUIREMENT QUESTIONS and
FOR PERMIT INFORMATION
EVERETT FIRE DISTRICT - https://everettwa.gov/FormCenter/Fire-Department-11/Operational-Permit-Mobile-Food-Vendors-90
Steve Goforth (FIRE DISTRICT) [email protected] WITH FIRE EQUIPMENT QUESTIONS.
ALL FOOD VENDORS WILL BE INSPECTED BEFORE THEY OPEN ON THE DAY OF THE EVENT.
REFUND POLICY: REFUND REQUEST (IN WRITING BY EMAIL OR MAIL) MUST BE MADE 30 DAYS PRIOR TO THE EVENT (BY JUNE 30th
2017). NO REFUNDS WILL BE MADE THE DAY OF THE EVENT IF THE VENDOR IS SHUT DOWN DUE TO NON-COMPLIANCE WITH
SCBHC/NUBIAN JAM COMMITTEES AND/OR HEALTH/FIRE DEPARTMENT.
Please complete the attached application, sign at the bottom and return with payment to:
The Snohomish County Black Heritage Committee
P.O. Box 1552
Everett, WA 98206
Attn: 2016 Nubian Jam
If you have any other questions or concerns please contact: Monet Bletson at 425-870-0680 or [email protected].
Date Received/Approved: _________________________________ Received By: _____________________________________
#of Years at Nubian Jam: ___________
PLEASE ASK FOR INFORMATION
ON BEING A SPONSOR!
VENDOR SPACE APPLICATION FORM
Any items with the words Nubian Jam or the Nubian Jam logo may not be sold without
the written permission of the Snohomish County Black Heritage Committee!
Type of Space:
Food
 ($200)
Business/Government  ($100)
*10x15 booth space + 1
electrical outlet*
Retail
 ($100)
Non-Profit Service
 ($25)
**Copy of Non-Profit Status provided by
IRS REQUIRED**
Describe Food/Retail items to be sold and/or Business, Service/Information/Non-Profit materials to be displayed (Be
as specific as possible, feel free to attach any additional information:
_______________________________________________________________________________________________
_______________________________________________________________________________________________
ALL Vendors: Once your item(s) have been approved, they are final! If you bring any items which are not
approved, you will be asked not to sell the non-approved item(s) and/or to close your booth – NO REFUND/
NO EXCEPTIONS!


Each additional 10x5 space is $50 more (max 10x20)
1 Electrical Outlet $25 fee for ALL Vendors
*First Come First Reserved as outlets are limited*


PLEASE BRING A STURDY TABLE OR PLACE TO DISPLAY YOUR ITEMS AS WELL AS CHAIR(S) IF NEEDED. ALL
VENDORS EXCEPT FOOD VENDORS WILL HAVE A 10 X 10 SPACE FOR YOUR DISPLAY. THERE WILL BE A $25/ITEM FEE
FOR USE OF TABLES, CHAIRS OR EXTENSION CORDS PROVIDED BY COMMITTEE. VENDORS ARE RESPONSIBLE FOR
YOUR OWN SPACE SET-UP AND CLEAN-UP … THE COMMITTEE WILL NOT PROVIDE SPACE SET-UP/CLEAN UP
ASSISTANCE.
THE NUBIAN JAM IS A ONE-DAY EVENT AND WILL BEGIN PROMPTLY AT 10:00AM.
SET UP IS BETWEEN 7:00A.M. and 8:30A.M. TAKE DOWN IS BETWEEN 5:30P.M. and 7:00 P.M.
All Vendors MUST BE set-up by 9AM. ***FOOD VENDORS MUST BE READY FOR HEALTH INSPECTION (i.e.
READY TO SERVE) NO LATER THAN 9AM*** NO EXCEPTIONS/NO REFUNDS
COMPANY NAME: _________________________________________________________________________________________________
CONTACT NAME: __________________________________________________________________________________________________
ADDRESS: _________________________________________________________________________________________________________
CITY/STATE/ZIP: ___________________________________________________________________________________________________
PHONE (
):____________________
EMAIL: ________________________________
AUTHORIZED SIGNATURE: _________________________________________________ DATE_________________________________
Date Received/Approved: _________________________________ Received By: _____________________________________
#of Years at Nubian Jam: ___________