Eastern Utah Public Safety
             
Vendor Booth Application Form
Friday 5th - 2 p.m. and Saturday 6th - 8 a.m.


Vendor Information
Organization Name:
Address:
Address:
City: State/Province: ZIP/Postal Code:
Phone: Email:
Contact Name
Type of Merchandise or Service
 
Booth set up time Sept. 5th from 8:00 a.m. - 2:00 p.m. Other arrangements must be per-approved.
LOADING AND UNLOADING AT NORTH END OF BUILDING. PARK IN DESIGNATED AREAS ONLY!!

 
BOOTH COSTS AND/OR PACKAGES (Please check package)
Non-Profit :     Select:    
                                                Includes a 10' X 10' space.
 
Sales Booth Packages:   $100.00   Select:   Item Subtotal:  
$0.00
                     Includes a 10' X 10' space and one meal voucher.
 
Break Sponsor:   $275.00   Select:   Item Subtotal:  
$0.00
                                      Includes a 10' X 10' space, one meal voucher and 3 minutes to talk at the end of a break to the audience.
                                      You are paying to provide the snacks during this break.

 
ADDITIONAL MEAL VOUCHERS
Please specify the number of additional meal vouchers needed. Do not count the meal vouchers included in package.
Meal Vouchers:   $25.00   Quantity:   Item Subtotal:  
$0.00
 
ELECTRICAL NEEDS
We provide 20 amp of 120 volt or a select number of 80 amps 208 volts. Any Additional power will need to be approved by the Event Center Staff.

If you will be using electricity in your booth, please specify the use and number of each item being used. i.e. Computer (2), Television (1),  Food Equipment Skillets (1), Roaster (1), Grills (1), etc.
If you do not fill this out in in its entirely you may not get power needed.
Electrical Items In Booth
Please specify other needs
 
Total:
$0.00
Payment Information
Method of Payment:
Update name from Vendor Information
Name of Individual
on Checking Account:
Name of Individual
on Savings Account:
Name of Business
on Checking Account:
Bank Routing Number:
Bank Account Number:
Credit Card Number: (Type number or swipe with cursor in this empty field)
Expiration Date: /
Card ID (CVV2/CID) Number: What is the Card ID?
Cardholder Information (exactly as it appears on your statement)
  Update from Vendor Information
Cardholder's Name:
Billing ZIP/Postal Code:

CARBON COUNTY FAIRGROUNDS

VENDOR'S RELEASE, WAIVER, AND INDEMNITY AGREEMENT

I hereby acknowledge that I have voluntarily applied to provide vendor services for Carbon County Fairgrounds activities, including, but not limited to food, beverages and other items for sale.

 AS LAWFUL CONSIDERATION of being permitted to enter upon and use the CARBON COUNTY FAIRGROUNDS and of being permitted to provide vendor services for any activities at the FAIRGROUNDS, I, the undersigned, for my heirs, distributees, legal representatives, next of kin and assigns agree to the provisions set forth below.

 1.    I hereby release, waive, discharge and covenant not to sue, make a claim against the property of or otherwise prosecute CARBON COUNTY, its Commissioners, employees or agents, hereafter collectively referred to as "COUNTY," for liability on account of damage to the property or injury to the person or death of the undersigned, whether caused from the passive or active negligence of the undersigned or injury to the person or death of any other person, while the undersigned is providing food, beverages or other vendor services at the FAIRGROUNDS facilities.

 2.    I hereby agree to indemnify and save and hold harmless the COUNTY from any loss, liability, damage or cost that COUNTY may incur due to any food, beverage or material which the undersigned sells, or any other act of the Undersigned while the Undersigned is using the FAIRGROUNDS facilities or selling food, beverages or any other materials.

 3.    I expressly agree that the foregoing Releaser Waiver and Indemnity Agreement is intended to be as broad and inclusive as is permitted by the laws of the State of Utah.  I further agree that if any provision of this agreement is held to be invalid, nevertheless the balance of the agreement shall continue in full legal force and effect.

 4.   I AGREE TO COMPENSATE OR REIMBURSE COUNTY FOR ANY COSTS, EXPENSES OR DAMAGES, INCLUDING ATTORNEY FEES, RESULTING FROM ANY CLAIM BROUGHT AGAINST COUNTY FOR PROPERTY DAMAGE, PERSONAL INJURY OR DEATH, WHICH ARISE AS A RESULT OF THE PASSIVE OR ACTIVE NEGLIGENCE OR OTHER ACT OF MINE WHILE PROVIDING, OR AS A RESULT OF PROVIDING FOOD, BEVERAGE OR OTHER VENDOR SERVICES AT THE FAIRGROUNDS.

 5.   I HAVE CAREFULLY READ AND FULLY UNDERSTAND THE COVENANT NOT TO SUE CONTAINED HEREIN AND VOLUNTARILY SIGN THIS RELEASE, WAIVER OF LIABILITY AND INDEMNITY AGREEMENT,

 In signing this application, I agree to abide by all rules and conditions of   Eastern Utah Emergency Services Symposium and release and forever discharge from any liability Carbon County, the event organizers, its sponsors, and their affiliated companies, officers, agents and employees. I will not hold event or event organizers responsible for loss due to damage or theft. I understand that the above event in no way guarantees any return or benefits. I understand these rules and regulations and agree to all the terms of this vendor agreement.

         By signing this, I agree that I have read both sides of application and I am over the age of 18 (eighteen).
Signature
Date
 
To help patrons visiting the booths, we will be putting together a Sponsor Director List to hand to each attendee. Please provide in 20 words or less a bio of your booth. If you have a show discount or special please include in bio.
Booth Bio
For Information Contact
     Scott Barney 435-820-0211                                             Justin Needles 435-630-4338
     scott.barney@carbon.utah.gov                                        justin.needles@carbon.utah.gov
 
Please be aware that credit card payments will reflect on your statement as
County UT 8007640844 ClintonUT
 
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