Producer/Processor Membership Application Section 1: Business Details Registered name of business Operating name of business Business owner or manager Contact Person Position Contact Number Email Mailing Address City/Town Postal Code Physical Address City/Town Postal Code Telephone Fax Email Website Social Media Information Twitter Instagram Facebook Product Information Brand Name of Product Product Description Primary Origin Where Processed/Packaged Section 2: Business Description Please provide a brief description your company and products. If you provide a consumer experience please describe the experience and how it exemplifies a Nova Scotia culinary tourism experience. Please note this description may be used in Taste of Nova Scotia promotional materials. *Please limit description to 100 words or less. Section 3: Producer/Processor Membership Fee Structure Producer/Processor membership fees are based on gross annual sales of product. Please select the applicable fee: ---$200,000 or less – $540.75 + HST = $621.86$200,001-$350,000 – $810.60 + HST = $932.19$350,001-$500,00 – $1,076.09 + HST = $1,237.50$500,001-$1,000,000 - $1,622.25 + HST = $1,865.59Over $1,000,000 - $2,163.00 + HST = $2,487.45 Application Fee: $100/business Please note the $100 application fee will be applied to the remaining Taste of Nova Scotia membership fees for all successful applicants. You will receive an email confirmation following the submission of your online application. Follow the link provided to pay your application fee online, or send a cheque to the Taste of Nova Scotia office. Your application will not be considered until payment for the application fee is received. Section 4: Declaration of Accuracy I declare that all information contained in this document is accurate at the time of signature. I have read and commit to the Taste of Nova Scotia producer/processor membership criteria. View Membership Criteria I agree to notify Taste of Nova Scotia of any changes to my business resulting in it no longer meeting all the required standards. I understand that my business may be visited during the operating season to ensure that all Taste of Nova Scotia required standards are being met, and that if the standards are found to not be met, my participation in Taste of Nova Scotia will be suspended or revoked. Applicant's name: Position: Date: (Date format: yyyy-mm-dd) Section 5: Eligibility Questionnaire Please help Taste of Nova better understand your company, by checking YES, NO or Unsure for each of the following questions. Please note the questions in bold are minimum required standards for Membership with Taste of Nova Scotia. If you do not meet some of the required standards please contact Taste of Nova Scotia. Member companies must have a head office and production facility in Nova Scotia and an ongoing interest in contributing to a healthier Provincial economy. They must produce a readily identifiable Nova Scotia product and utilize NS primary production, goods and services whenever practical. Do you have a head office in Nova Scotia? ---YesNoUnsure Do you have a production/processing facility located in Nova Scotia? ---YesNoUnsure Is the product produced and/or processed in Nova Scotia by the applicant? ---YesNoUnsure Is this product grown in Nova Scotia by the applicant? ---YesNoUnsure Do you actively support purchasing of goods and services from other Nova Scotia firms when supply is available and quality and price are competitive? ---YesNoUnsure Is your company's brand or corporate identity affixed to the product? ---YesNoUnsure Member companies must comply with applicable regulatory requirements and will demonstrate a commitment to continuous improvement through quality assurance documentation (e.g., HACCP, Good Manufacturing Practices, ISO). Do you have a federal or provincial licence to operate a food facility? ---YesNoUnsure Do the products you sell fall under provincial and/or federal regulations? ---YesNoUnsure Have you consulted a health and safety office for clarification of your legal responsibilities as a producer of food sold for human consumption? ---YesNoUnsure Have you documented minimum acceptable quality standards for your product? ---YesNoUnsure Are key ingredients & starting materials evaluated for acceptability prior to use for production? ---YesNoUnsure Do you check and document cleanliness of the processing environment and food equipment prior to start of daily production? ---YesNoUnsure Do you use product and premises inspection checklists with defined acceptance and rejection criteria? ---YesNoUnsure Do you have a written traceability program and recall plan? ---YesNoUnsure Member companies will have demonstrated an ability to sustain operations and must develop and maintain marketing, customer satisfaction and customer service strategies in sync with the Taste program philosophy. Membership terminates on change of ownership. New owners may apply for reassessment. Do you have a business continuity plan? ---YesNoUnsure Do you have a business succession plan? ---YesNoUnsure Can you provide two credit references, upon request? ---YesNoUnsure Do you have a minimum $2,000,000 public liability insurance coverage? ---YesNoUnsure Do you plan to use the Taste of Nova Scotia logo? ---YesNoUnsure Do you anticipate adding to your product offerings within the next three years? ---YesNoUnsure Product Quality and Food Safety Knowledge Have you investigated food safety hazards and risks typically associated with this type of product? ---YesNo Briefly describe what steps you have taken to understand factors effecting the safety and wholesomeness of this product. Briefly describe how you ensure the safety of this product for human consumption.