Licensee Application - New Mexico Certified Chile

New Mexico Chile Association
New Mexico Chile Certification Program
P.O. 27186
Albuquerque, NM 87125
(575) 489-6449
Application for Licensure for use of Certification
Mark for New Mexico Certified Chile™
Business name:
Telephone number(s):
Fax number(s):
Email address:
Web address of business:
Person responsible for program:
Name of Operation (Corporation, Partnership,
Individual, Other):
Position of person responsible for program:
Mailing address:
Physical address (if more than one location,
please list):
Type of application:
□ First application
□ Product extension
□ Renewal
Licensee Category Definitions:
The categories of operations that may utilize the Mark are defined as follows:
1. Farmer: grows a chile crop and sells the crop without further processing.
2. Small Local Farmer: grows a chile crop on a small scale and sells the crop without further
processing other than on-site roasting. They must grow the crop themselves and must
not earn over $10,000 gross sales from all sales of all chile products annually.
3. Growers Market: a multi-stall market where farmers and vendors sell produce and other
products to the general public.
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4. Produce Vendor: wholesales a fresh, unprocessed chile crop to retailers, commercial,
institutional, or other professional business users. Produce vendors may sort, wash, and
package for sale.
5. Processor: processes a fresh chile crop into another product that can be stored.
Processes include: dehydrating, roasting, steaming, canning, jarring, freezing,
fermenting, preserving. Processed product is solely composed of chile peppers along
with other process aids such as acidification.
Category of operations that will use the Certification Mark (check
all that apply)
□ Farming
□ Small Local Farming
□ Growers Market
□ Produce Vendor
□ Processing
1. Please attach a list of New Mexico Certified Chile™ suppliers
2. For Farmers only: List locations of growing areas of New Mexico
Certified Chile™ (use extra sheets if necessary)
County
GPS coordinates
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3. For Farmers only, please attach a list of current Licensees that use
New Mexico Certified Chile™
4. Please attach a list of all products (including UPCs if available) that
will utilize the Certification Mark. This list must be updated if
additional products are certified and sold during the license period.
5. Please attach clear photographs, scans, or artwork of all products
that will use the Certification Mark for New Mexico Certified Chile™.
6. Do you use or grow both New Mexico and non-New Mexico grown
chile peppers? (Yes/No). If Yes, check off the following boxes:
New Mexico
Grown/Used
Non-New Mexico
Grown/Used
N/A
Green Chile
Red Chile
Jalapeno
Cayenne
Other pepper
7. If yes, describe your method to keep separate and trace New Mexico
grown from non-New Mexico grown? (attach extra sheets if
necessary)
8. Do your products refer to or advertise any geographic location (eg.
Lemitar, Hatch, Chimayo, Deming chile)? (Yes/No) If yes, please list
products below (attach or email extra sheets if necessary).
9. For all products that refer to a geographic location, are your
products grown in that location described on labels or advertising?
(please explain, attach or email extra sheets if necessary).
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Fee Structure:
Please submit the approximate usage fee based on the previous year’s New
Mexico Certified Chile™ sales, or an estimate if none. Small Farmers and
Growers Market Licensees are exempt from fees.
1. Processor and Produce Vendor Licensees will pay all applicable Usage Fees:
a. Fresh or processed chile except dry: $.005/lb. of New Mexico Certified
Chile sold or used internally for manufactured products, and
b. Dry Chile: $.01/lb. of New Mexico Certified Chile sold or used internally
for manufactured products, or
c. Licensees may opt to have unlimited use of the Mark for New Mexico
Certified Chile chile in accordance with the program guidelines for a fee
of $30,000 annually in two equal payments in accordance with the Usage
Fee payment schedule.
2. No other Licensee or Permitted User will pay Usage Fees.
All companies that are separate entities regardless of ownership must submit
separate Applications/Renewals/Product Extensions. A usage fee is due for
products in each class of business in which it is certified.
Please estimate annual New Mexico Certified Chile™ sales and apply the applicable fee
based on the category of operations. This is an estimate only, and fees will be paid on
actual quantity of New Mexico Certified Chile™ sold or used, depending on your
category. If you are not required to pay a per pound usage fee, leave this blank.
Type of Chile
Estimated Annual Total
of New Mexico Certified
Chile™ lbs. packaged
and/or processed
Dates product will
be packaged
and/or processed
$.005/lb
(Packaged Fresh
and/or Processed)
Green/Red
$.01/lb
(Dehydrated)
(Packaged Fresh
and/or Processed
and/or Dehydrated)
Total Estimated
Fee
Example:
7/1/16-11/30/16
Green/Red
Green/Red
Fee
Unlimited use of mark.
$30,000
$30,000
Total
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Please email your logo or a picture of your choosing to
[email protected] to be featured along with your business name on
the New Mexico Certified Chile™ website.
□
I would not like to have my business name and logo/picture of my choosing
featured on the New Mexico Certified Chile™ website.
I, the applicant, have read, understood, and agree to all program elements
defined in the Application, Program Guidelines, and License Agreement
and signed Program Guidelines and License Agreement are attached to
this Application. Failure to follow program elements may result in a denial
of application or loss of New Mexico Certified Chile license.
Signature of Applicant:
Date:
___________________________________________________
__________
Title:
_____________________________
Please attach a check for the annual participation fee made out to the New
Mexico Chile Association.
Email or mail this application to:
[email protected]
P.O. Box 27186
Albuquerque, NM 87125
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