Delta Agricultural Society 110 Mill Creek Drive P. O. Box 220 Delta, Ontario K0E 1G0

Concession Application Form

Deadline: July 11th, 2013

Company Name: _______________________________________________________________________

Company Contact: _____________________________________________________________________

Address: ______________________________________________________________________________

Street Address________________________________________Postal Box Number________________

Postal Code ________________________________________

Contact Numbers:

Phone / Fax: ______________________________________________________

Email: ____________________________________________________________

Location of Space Required: Indoor________ Outdoor________

Type of Products to be Sold/Displayed: ____________________________________________________

Hydro Required ( ) No ( ) Yes

If Yes, what for? ______________________________________

Please enter the applicable calculations to complete this application form.

Water Required ( ) No ( ) Yes           If Yes, what for? ______________________________________

Total Feet of Frontage: ______________ x $8.00  =                                                    $__________________

Basic Hydro: Not optional                                                                                                               20.00

Additional Hydro/ Number required at $30 per outlet ____x$30 =                        $__________________

Sub-Total (total of above three lines)                                                                          $__________________

HST 13% (#12345 2492 RT)                                                                                                $______________

Total (total of all lines) $__________________

Please make all cheques / money orders payable to the DELTA AGRICULTURAL SOCIETY.

Concessionaires must carry a minimum of $1 million ($1,000,000.00) liability and loss of property

insurance. A photocopy of the policy must be submitted with the Concession Application Form.

Hold Harmless Agreement

I, The Concessionaire, shall indemnify and HOLD HARMLESS the Delta Agricultural Society, their

members, agents and employees from and against all claims, demands, losses, costs, damages, actions,

suits or proceedings by any third parties that may arise out of, or may attribute to all operations

performed by or carried out by the Concessionaire, his/her agents, employees or servants, or for whose

acts he/she may be held liable howsoever caused.

The undersigned hereby agrees to accept and abide by the Hold Harmless Agreement, all Terms and

Conditions and the decisions of the Concessions Committee of the Delta Agricultural Society.

Name: _____________________________________

Please Print

Signature: __________________________________

Date: ______________________________________

FOR OFFICE USE ONLY

Date Application Received: __________________

Payment Enclosed: ( ) Yes  ( ) No

Payment Method: _________________________

Receipt Issued: ( ) Yes ( ) No

Proof of Insurance Enclosed: ( ) Yes ( ) No

Date Application Copied: ___________________