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. NM Chile Certification™ - Application for Licensure (Updated 8/29/16) 1 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 NM Chile Certification™ - Application for Licensure (Updated 8/29/16) 2 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). NM Chile Certification™ - Application for Licensure (Updated 8/29/16) 3 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 NM Chile Certification™ - Application for Licensure (Updated 8/29/16) 4 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 NM Chile Certification™ - Application for Licensure (Updated 8/29/16) 5
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