2024 Farmers Market Liability Coverage Application

2024 Farmers Market General Commercial Liability Coverage Application

Insured: Massachusetts Federation of Farmers' and Gardeners' Markets INC.
Deadline is 2 weeks prior to market opening date. Anything less than two weeks notice will incur an additional expedited processing fee of $25.

If you have any questions, please contact Bill Grace, Liability Assistant at 781.893.8666 or by email at liability@massfarmersmarkets.org.
This is an application to obtain commercial liability coverage by being added to MFM’s general commercial liability insurance and umbrella liability insurance policies as an additional insured. This coverage is only available to farmers markets and not to individual farmers/vendors.

Policy limits are as follows:
- General Commercial Liability - $1 million/occurrence, $2 million aggregate limit
- Umbrella Liability - $5 million/occurence, $5 million aggregate limit
- Aggregate limits are shared amongst all additional insureds.
A copy of the full policy is available upon request or on the MFM Farmers Market Members Basecamp for existing MFM members.
PLEASE NOTE
- Submission of your application does NOT constitute coverage.
- You do NOT have liability coverage until you receive your Certificate of Insurance.
- Your Certificate of Insurance will be emailed to you once it is available from the insurance company and payment has been receive.
Type of Submission
What do you need to do?

Renewal applicationNew applicationAdd the info for my second season (existing 2023 ANNUAL plan subscribers only)
Market Information
Market name:*
Who is the organization running the market? *
The underwriter requires the legal name of the business entity, such as a government entity, non-profit corporation, limited-liability corporation (LLC), limited partnership (LP), or unincorporated association. If you own the market as a sole proprietor, please include your name and d/b/a information. For existing 2023 ANNUAL subscribers adding information for your second season, it is IMPORTANT that this info matches the info you previously submitted.
Market location:*

Street Address

Street Address Line 2

CityState

Zip Code
Market start date:*

MonthDayYear
Date
Email
example@example.com
Market end date:*

MonthDayYear
Date
Which day of the week is the market?*
Ex. Saturday
What time do you start setting up the market?*

:HourMinutesAM/PM Option
What time does the market open?*

:HourMinutesAM/PM Option
What time does the market close?*

:HourMinutesAM/PM Option
What time do you finish breaking down the market?*

:HourMinutesAM/PM Option
Is there a 2nd market day? Answer yes only if the market is in the same location for more than one day. Second day must be at the same location.*

YesNo
Which day of the week is the 2nd market?
Ex. Saturday
What time do you start setting up the 2nd market?
What time does the 2nd market open?
What time does the 2nd market close?
What time do you finish breaking down the 2nd market?
If your market doesn't run weekly, please specify frequency or dates
On-site market manager:*

First NameLast Name
Phone number:*

Area CodePhone Number
Market Manager Email:

Contact Person

The Certificate of Insurance will be emailed to this person.
Contact person name:*

First NameLast Name
Phone number:*

Area CodePhone Number
Contact Person Email:*

Confirmation Email
Mailing address:*

Street Address

Street Address Line 2

CityState

Zip Code
Certificate Holder
Certificate Holder Name:*
This should be the name of the business that runs the market. For example: Acme Farmers Market Inc. If you own the market as a sole proprietor, please list your name followed by your d/b/a information. For example: Sarah Farmer, d/b/a Anytown USA Farmers Market.
Phone number:

Area CodePhone Number
Certificate Holder Email:
Business address:*

Street Address (no PO Boxes allowed)

Street Address Line 2

CityState

Zip Code
Mailing address (if different than business address):

Street Address or PO Box

Street Address Line 2

CityState

Zip Code
List the names of all people (paid and volunteer) involved in the running of the market. The insurance company no longer charges for these persons as additional insureds.*

Terms & Conditions
It is mandatory that markets require their vendors to maintain a commercial general liability policy. Policy limit must be a minimum of $1 million per occurrence with a $2 million aggregate limit. Each vendor policy needs to list the market as an additional insured or contain a blanket additional insured endorsement and provide the market with a certificate of insurance confirming coverage.
I confirm that my market complies with the vendor liability requirements.*

YesNo
Any changes to the market that affect liability coverage, including but not limited to dates, location(s), or additional insureds must be communicated to MFM as soon as they are known.
I agree to notify MFM of any changes that affect liability coverage.*

Yes
Signature*
To sign application within box above:
- On a touch screen device, use your finger or a stylus
- On your computer, place the cursor within the box & sign using mouse
- If you have trouble signing in the box above, save application & check:
  - Is your browser is updated to the most recent version
  - Try a different browser (Chrome works reliably)
  - If you're using a mobile device, try downloading the JotForm app

Select Your Liability Plan
Are you a 2024 member of Mass Farmers Markets?*

YesNo
Note: Annual membership runs Jan. 1 to Dec. 31 and costs $120. You MUST be a 2024 member of MFM to qualify for the discounted MEMBER liability coverage rate.

You can sign up or renew your membrship here: 2024 Market Membership Registration Form

Detailed liability coverage pricing available here: MFM 2024 Liability Coverage Pricing
Select a liability coverage plan (hover over field to see what's included with each plan):*

MEMBER Seasonal: $410Non-Member Seasonal: $530MEMBER Annual: $600Non-Member Annual: $940Another agreed amount between you and MFM
What is the agreed amount?
Additional Insureds
- List only property owners, corporate owners, or property managers, not individuals.
- Do not include the organization running your market. That one is implied and already included.
- If you need more than 3 additional insureds, please contact liability@massfarmersmarkets.org before proceeding.
- Make sure you include any party you are contractually obligated to cover, such as the property owner, if applicable.
How many additional insureds do you need?*

Additional Insured #1
Name #1*
Address #1*

Street Address

Street Address Line 2

CityState

Zip Code
Phone #1*
Role of Additional Insured #1*
Examples include landlord, property owner, property manager, municipality, state agency

Additional Insured #2
Name #2*
Address #2*

Street Address

Street Address Line 2

CityState

Zip Code
Phone #2*
Role of Additional Insured #2*
Examples include landlord, property owner, property manager, municipality, state agency

Additional Insured #3
Name #3*
Address #3*

Street Address

Street Address Line 2

CityState

Zip Code
Phone #3*
Role of Additional Insured #3*
Examples include landlord, property owner, property manager, municipality, state agency

Billing
You indicated
Additional insureds
Season plan includes
Additional insureds
Annual plan includes
Additional insureds
How many EXTRA additional insureds do you need to pay for, beyond what your plan includes?

None1 extra - add $532 extra - add $1063 extra - add $159
Total Cost for Liability Coverage
Auto-calculated based on your selections
For an ANNUAL Liability Plan, choose:*

Split billingBill me for the full amount shown
Total Cost for EXTRA Additional Insureds
Auto-calculated based on your selections

NEXT STEPS:

Once submitted, you will receive a copy of your application via email from JotForm. If you choose to not make your liability payment online right now, you will receive a separate email with an invoice for payment. This can take up to a week.

To ensure you receive all communications from us in a timely manner, please make sure to add noreply@jotform.com, finance@massfarmersmarkets.org, and liability@massfarmersmarkets.org to your email Safe Sender list.

If you require assistance regarding liability coverage, please email liability@massfarmersmarkets.org or call Bill Grace at (781) 893-8666.

To learn more about Mass Farmers Markets, please visit massfarmersmarkets.org.

Have a wonderful market season!
PAYMENT
If you would like to pay by check, simply press the SUBMIT button and you're done! Our Finance Dept will email you an invoice. This can take up to a week.

If you'd like to PAY NOW via PayPal or Debit/Credit Card, click the appropriate button below to process your payment, and then press the SUBMIT button after you have processed your payment.

PLEASE NOTE:
Online payment of your premium does NOT constitute coverage.
You do NOT have liability coverage until you receive your Certificate of Insurance.

Your Certificate of Insurance will be emailed to you once it is available from the insurance company and payment has been receive.
You have selected an ANNUAL plan with SPLIT BILLING. Our Finance Dept. will send you an invoice. This can take up to a week. You can then pay via check or PayPal.

Please press the SUBMIT button below to send us your application.
Select Your PAYMENT METHOD

Pay NOW by PayPal, credit card, or debit cardPay LATER by check
Liability Plan Cost

prevnext( X )
USDDescription

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Season	MEMBER	NON-MEMBER
Winter (Billed ~Nov/Dec)	$190	$410
Summer (Billed ~April/May)	$410	$530

2024 Farmers Market General Commercial Liability Coverage Application

Type of Submission

Market Information

Contact Person

Certificate Holder

Terms & Conditions

Select Your Liability Plan

Additional Insureds

Billing

PAYMENT