Nevada Senior Farmers’ Market Nutrition Program Certified Farmer/Vendor, Roadside Stand, Bulk Agreement Purpose of the Senior Farmers’ Market Program: To increase the consumption, production, and distribution of locally and domestically grown fresh fruits, vegetables, herbs and honey, while supplementing the nutritional needs of Nevada's lowincome seniors through a coupon redemption system. Locally grown means that the product was grown either in Nevada or in adjacent neighboring states to Nevada (California, Oregon, Idaho, Utah & Arizona). Terms and Conditions: Provide State with information requested for reporting purposes; Only eligible foods may be purchased with coupon(s); Provide eligible foods at or less than price charged to other customers and offer same courtesies; Accept coupons within the dates of their validity and submit reimbursements within the time period listed on program documents (NO EXCEPTIONS); No cash change will be issued for purchases that are in an amount less than the value of the coupon(s); Accept training on SFMNP procedures and provide employees with SFMNP responsibilities on such procedures; Farmers agree to sell only locally grown products that have been approved by State Agricultural Representatives; Agree to be monitored by State and Federal reviewers; No state/local tax will be collected on purchases of food using SFMNP coupons; All reimbursement claim forms must be submitted using the Farmer Redemption Code provided by the NV State Office (copies of original form allowed); Be accountable for actions of farmers or employees in the provision of eligible foods and related activities; Pay State agency for coupons transacted in violation of the policies and procedures of this program; Comply with nondiscrimination policies and procedures; Notify State agency when ceasing operations prior to end of authorized period of agreement; Shall not seek restitution from participants for coupons not reimbursed by State; Description of Sanctions: Corrective action may include, but is not limited to, repayment of coupons reimbursed under fraudulent means and possible termination from participation in this program. THIS APPLICATION WILL BE VALID FOR A TWO (2) YEAR PERIOD UNLESS OTHERWISE INDICATED.
PLEASE COMPLETE THE FOLLOWING: Name of Certified Farm: _____________________________________________________________________________ Name of Certified Farmer : ___________________________________________________________________________ Name to Appear on Reimbursement Check: ______________________________________________________________ Mailing Address:____________________________________________________________________________________ Address
City
State
Zip Code
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Business Phone Number
Cell Phone Number
EMAIL Address
By signing this agreement, I understand and agree to the terms and conditions listed above. _________________________________________________________________________________________________ Certified Farmer’s Signature Date For Official Use Only Market Manager: ____________________________________ Signature
__________________ Date
Approval By State: ___________________________________ ACCEPTED BY Date
__________________ Program Years
This institution is an equal opportunity provider.
ASSIGNED REDEMPTION CODE: __________________