Montgomery County Department of Health and Human Services Licensure and Regulatory Services 255 Rockville Pike, Suite 100; Rockville, Maryland 20850 Phone: 240-777-3986 Fax: 240-777-3088 FARM MARKET/FARMER'S MARKET LICENSE APPLICATION
TODAY'S DATE: _ _ _ _ __
Type of Market: Farm Market / Roadside Stand
Type of Farmer: Farmer
D
Itinerant
D
Farmer's Market
D
D
Name of Facility:
Telephone No. (with area code):
Owner/Corporation Name:
Fax No.:
Address of Owner/Corporation:
(include street number, suite number, street name, city, state, and zip code)
Email: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Federal Tax Identification No.:
Workers' Compensation Insurance Company Name:
Policy/Binder No.:
Check here D if this facility is operated by a sole proprietor with no employees, or by members of a partnership or LLC,
and a Certificate of Compliance has been obtained.
D
D
D
On-SitelWell:
Sewage at Facility: Public:
On-Site/Septic System: D
Water Supply at Facility: Public:
(NOTE: If water or sewage system is on-site and outside of Montgomery County, MD, submit a copy of the most recent
certificate of compliance)
Address of the Farm/Farmer's Market(s):
Days and Hours of Operation: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Are Products Sampled? Yes:D No:D
List of All Foods Sold or Sampled:
Type of License: F1:
D
F2:
D
F3:
D
NF1:
D
NF2:
D
NF3:
D
NF4:
D
(See Page 2 for types of licenses)
I hereby certify that the above information is accurate and complete:
Signature of Owner or Agent: Printed Name and Title of Above Signatory: NOTE: LICENSES ARE NOT TRANSFERABLE FROM PERSON TO PERSON
Payment Method: Cash is not accepted. Fax credit card payments to 240-777-4531 (confidential fax line).
D
Check
D
Money Order
D
Visa
D
Mastercard
Organization: _ _ _ _ _ _ _ _ _ _Fee: $,_ _ __
Submit completed application and fee to DHHS/Licensure & Regulatory Services. Make checks or money
orders payable to "Montgomery County, Maryland". Credit Cardholder's Name: _ _ _ _ _ _ _ _ _ _ _ _ Credit Card No: _ _ _ _ _ _ _ _ _ _ __ Exp. Date: _ _ _ _ _ _ _ _ _ Amount: $_ _ _ _ _ __
I agree to pay the indicated total amount according to card issuer agreement:
Cardholder's Signature: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
OFFICE USE ONLY Receipt No: _ _ _ _ _ _ _ __
Date Issued: _ _ _ _ _ _ __
Amount Paid: $_ _ _ _ _ _ __
Date Expires: _ _ _ _ _ _ __
Check/Money Order No: _ _ _ __
Record No: _ _ _ _ _ _ __
FEE SCHEDULE
Type of License
**
Fee
**
Whole, Uncut, and Unwashed Agricultural Produce and Live Crustacea Do Not
Require a License:............... ........................... ......... ......... ...........................
FARMERS (Licenses are valid from April 1st to November 30th and apply for ALL
Farmer's Markets located in Montgomery County):
No Fee
F1 (Selling pre-packaged non-potentiallv hazardous food such as jams, jellies, fruit
butter, or baked goods):...... ... ............ ...... ......... ...... ... ...... ......... ...... .........
$25.00
F2 (Selling open or potentially hazardous food such as meat, ~ggs, cheese, cider, or
cut melons that are produced on the farm): .................. '" ......... ...... ...... .........
$50.00
F3 (More than 25% of a farm market is used for the display and sale of agricultural
products not produced on the farm)......... ......... ............ ............... ....... .........
$175.00
ITINERANT FOOD VENDORS SELLING AT FARMER'S MARKETS (Licenses are
valid for one location only and are not transferable from location to location)
NF1 (Selling prepackaged, non-potentially hazardous food at a single location for not
more than 14 days):...... ... ... ... ...... ...... ... ................. ... ..................... ..........
$40.00
NF2 (Selling prepackaged, non-potentially hazardous food at a single location from
April 1st to November 30th):.... ... .•. ...... ......... ...•.. ...... ......... ....... ..................
$175.00
NF3 (Selling open or potentially hazardous food at a single location for not more than
14 days):............ ........... ............ ........................ ......... ......... ...... ...... ....
$65.00
NF4 (Selling open or potentially hazardous food at a single location from April 1st to
November 30th):... ...... ................................. ...........................................
$175.00
NOTE: Itinerant Food Service Facility - A temporary or special food service facility:
1. That operates at a fixed location for a temporary period of time such as a fair,
carnival, public exhibition, construction project, recreational facility, or similar
gathering; or,
2. Is a mobile unit that travels from place to place.
2
Completing the Farm Market (Roadside Stand) and Farmer's Market License Application (Please Write Legibly)
1. Today's Date :- Indicate the date that the application was completed.
2. Type of Market - A Farm Market is a market located on the farm. A roadside
stand is a stand located along a Montgomery County roadway. In addition to
obtaining licensure & Regulatory Services approval to operate, approval must
. also be obtained from the Department of Permitting Services, prior to operating a
roadside stand. A Farmer's Market is a market operated in conjunction with the
Montgomery County Department of Economic Development.
3. Name of Facility - Write the full name of the farm business where the
food/produce originates or is processed. "fhe name of the facility does not
include second party businesses where food 1s purchased for sale at the
farmlfarmers market.
4. Telephone Number - Write the telephone number of the facility, including area
code.
5. Owner/Corporation Name - Write the name of the facility's owner. If the owner
is a corporate entity, write the name of the corporation.
6. Fax Number - Write the fax number, if one is available, of the facility, including
area code.
7. Address of Owner/Corporation - Write the complete address of the owner or
corporation. Include the street number. suite number or letter (if appropriate).
and street name.
S. Email - Write the email address, if one is available, of the facility.
9. Federal Tax ID - The Federal Tax 10 (also referred to as the Employer
Identification Number or EIN) is used to identtry a business entity and must be
provided on the application. The Internal Revenue Service will issue an EIN
without charge. Refer to the IRS website at www.lRS.gov/businesses/small for
more information.
10. Workers' Compeosation Insurance - Every employer in the State of Maryland
with one or more employees must provide workers' compensation coverage for
all employees (with exceptions). An officer or member of a business may apply
for exclusion from coverage. A sole proprietor or partnership (without
employees) may apply for a certificate of compliance. Refer to the website at
www.wcc.state.md.us or caIiS00-492·0479 for more information.
11.Water Supply - If the water supplied at your farm or at the location where" food is
processed or prepared, is provided by the Washington Suburban Sanitary
Commission (WSSC), the City of Rockville, the City of Poolesville, or a local
community water supply, check the "Public" box. If your water is supplied by an
on~site well, check the "On~siteJ\IVell" box.
Sewage - If the sewage disposal system on the farm or at the Jocation where
food is processed or prepared is provided by the Washington Suburban Sanitary
Commission (WSSC), the City of Rockville, the City of Poolesville, or a local
community sewage system, check the "Public" box. If your sewage disposal is
provided by a septic system, Check the "On-site/Septic System" box.
If you reside in Montgomery County, Maryland, you must contact the Department
" of Permitting Services, Office of Well & Septic (240-777-6160) to schedule a well
sample -and inspection of the septic system. Allow a minimum 30 days to have
the inspection or sampling conducted and results received. If your on-site
sewage system is located outside of Montgomery County, Maryland, submit a
copy of the most recent certificate of compliance from your local government.
12. Address of the FarmlFarmer's Market (s) - Write the complete address of the
farm market or the location of the farmer's market. Include the street number (if
appropriate) and street name. For roadside stands, indude the block number
and/or nearest cross street.
13.Days and Hours of Operation - Write the days of the week and hours that the
facility is open for business.
14.Are Products Sampled? -Indicate whether or not the facility will sample
products to the customer.
15.list of All Foods Sold or Sampled - List all of the food items that the facility will
sell or sample at the farm market or farmer's markets. Indude all produce items,
foods prepared by the facility, and commercially prepared foods.
16.Type of License - Jndicate the type of license the facility is requesting. A
"fanner" is an entity recognized as a farmer by the Montgomery County
Department of Economic Development. A "non-farmer" includes all other
facilities, corporations, or organizations providing or selling food at a farmer's
market. "Non-farmers" may not obtain a license to provide or sell food at a farm
or roadside stand. The types of license are:
F1: A farmer selling prepackaged non-potentially hazardous food. Foods must
be commercially packaged or packaged on the farm;
F2: A farmer selling open or potentially hazardous food that has been produced
on the farm;
F1 and F2 licenses will be valid at all Montgomery County Farmer's Markets.
The license will list the Fanner's Markets at which you pran to operate, as
indicated on the application.
NF1: A non~farmer selling prepackaged, non-potentially hazardous food at a
single location for not more than 14 days;
NF2: A non-farmer selling prepackaged, non-potentially hazardous food at a
single location from April 1S to November 30th •
NF3: .A non-farmer selling open or potentially hazardous food at a single location
for not more than 14 days.
NF4: A non-farmer selling open or potentially hazardous food at a single location
from April 1st to November 30th •
17. Signature of Owner or Agent - The owner or owner's agent must sign the
application and then print the signatory's name and title.
02109
Montgomery County Department of Health and Human Services Licensure and Regulatory Services 255 Rockville Pike, Suite 100; Rockville, Maryland 20850 240-777-3986 (office) 1240-777-3088 (fax) Farmers' Market Sampling Guidelines
1. All food preparation must occur on site or from a licensed facility. Private homes
are not acceptable except for non-potentially hazardous food items previously
approved by the Montgomery County Health Department.
­
2. All water must come from an approved potable source. Approved sources include
bottled water and potable water in a food-grade container or storage tank.
3. Provide a hand washing station consisting of:
a) A container of water with a hands free dispensing valve.
b) A waste water catch basin.
c) Potable water at lOO°F (COMAR lO.15.03.l9.L(2)(b).
d) Liquid hand washing soap.
e) Paper towels.
4. Provide utensil washing station consisting of adequately sized containers: one
with soapy water for washing, one with clean water for rinsing, and one with
bleach in water for sanitizing (use one tablespoon of bleach for each gallon of
water to provide a solution of 50 parts per million (ppm) residual chlorine.
5. Cutting boards, knives, and other food equipment must be properly cleaned and
sanitized prior to operation and routinely as contamination occurs.
6. Fruits and vegetables intended for sampling must be rinsed thoroughly in potable
water. Washing is to remove dirt, soil, and any other contaminants. A chlorine
solution, or antiseptic vegetable wash, is strongly recommended.
7. All exposed food must be protected from contamination by the use of sneeze
guards, containers with lids, restricted opening containers, aluminum foil, or other
approved barriers.
8. Minimize bare hand contact with ready-to-eat food by wearing plastic gloves or
using clean and sanitized utensils, foil, or wax paper. Hands must be washed prior
to using gloves or other means. Change gloves between tasks or when tom or
soiled.
---------------
9. The use of common containers by the public for the tasting of foods is not
permitted. Use tooth picks, wax paper, paper sampling cups, squeeze bottles, or
disposable utensils to distribute samples. The idea is to prevent customers' hands
or fmgers from touching the samples or contaminating the food.
10. Maintain proper food temperatures for cold food at 41°F; or below and hot food
at 135°F; or above.
Montgomery County Department of Health and Human Services
Licensure and Regulatory Services
255 Rockville Pike, Suite 100; Rockville, Maryland 20850
240-777-3986 (office) / 240-777-3088 (fax)
Farmers’ Market Sampling Guidelines
1. All food preparation must occur on site or from a licensed facility. Private homes
are not acceptable except for non-potentially hazardous food items previously
approved by the Montgomery County Health Department.
2. All water must come from an approved potable source. Approved sources include
bottled water and potable water in a food-grade container or storage tank.
3. Provide a hand washing station consisting of :
a) A container of water with a hands free dispensing valve.
b) A waste water catch basin.
c) Potable water at 100°F (COMAR 10.15.03.19.L(2)(b).
d) Liquid hand washing soap.
e) Paper towels.
4. Provide utensil washing station consisting of adequately sized containers: one
with soapy water for washing, one with clean water for rinsing, and one with
bleach in water for sanitizing (use one tablespoon of bleach for each gallon of
water to provide a solution of 50 parts per million (ppm) residual chlorine.
5. Cutting boards, knives, and other food equipment must be properly cleaned and
sanitized prior to operation and routinely as contamination occurs.
6. Fruits and vegetables intended for sampling must be rinsed thoroughly in potable
water. Washing is to remove dirt, soil, and any other contaminants. A chlorine
solution, or antiseptic vegetable wash, is strongly recommended.
7. All exposed food must be protected from contamination by the use of sneeze
guards, containers with lids, restricted opening containers, aluminum foil, or other
approved barriers.
8. Minimize bare hand contact with ready-to-eat food by wearing plastic gloves or
using clean and sanitized utensils, foil, or wax paper. Hands must be washed prior
to using gloves or other means. Change gloves between tasks or when torn or
soiled.
9. The use of common containers by the public for the tasting of foods is not
permitted. Use tooth picks, wax paper, paper sampling cups, squeeze bottles, or
disposable utensils to distribute samples. The idea is to prevent customers’ hands
or fingers from touching the samples or contaminating the food.
10. Maintain proper food temperatures for cold food at 41°F; or below and hot food
at 135°F; or above.
Items for proper sampling
Bottom left to right:
disposable single use utensils, covered sampling container, tongs, knife and cutting board
Top left to right:
Waste basket with liner, disposable latex or plastic gloves
Examples of approved sampling methods.
Provide containers with hinged
covers and toothpicks to prevent
food contamination.
Use of tongs to give out sample.
.
Vendor is in complete control of the sampling process.
Covered Sample Set-up
Here is another example of how to protect your samples. Notice the samples have tooth picks already so
customer does not have to touch the sample. Cake cover acts as a sneeze protector.
Sampling of nuts using a nut-shaker.
HAND WASHING AND UTENSIL WASHING REQUIREMENTS
Hand-Washing Facilities – Provide a water container with a dispensing valve to leave hands free
for washing; a waste-water container; soap dispenser and paper towels for hand washing within
the food booth. Hand-washing facilities shall be separate from the utensil washing sink.
Utensil-Washing Facilities – Booths with food preparation require three containers for the
cleaning of equipment, utensils and for general cleaning purposes. One shall contain soapy water,
one with clear rinse water, and, and the third a bleach/water solution (use 1 tablespoon of
household bleach per gallon of water.)
All wastewater must be disposed of in an approved manner.