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Home My WebLink AboutTransient Merchant License - Country Fresh FarmsINTER -OFFICE MEMORANDUM BOARD OF PUBLIC WORKS DATE: August 6, 2025 TO: Chris Dressel, Community Investment Derek Erquhart, Fire Department Brad Rohrscheib, Police Department Randy James, Building Commissioner FROM: Hillary Horvath, Clerk hhorvath(a)_southbend in. gov SUBJECT: TRANSIENT MERCHANT LICENSE RENEWAL RECOMMENDATION APPLICANT: Country Fresh Farms LOCATION: Menard's Parkina Lot — 4640 S. St. Joseoh St. DATE OF EVENT: September 10-12, 2025 PLEASE INSERT YOUR RECOMMENDATION IN THE APPROPROIATE FIELD BELOW, BASED ON THE FOLLOWING ORDINANCE CRITERIA (sec. 4-60): Community Investment: Favorable Recommendation Police: Favorable recommendation Fire: Favorable Recommendation (Tent to be inspected once erected for compliance) Building Department: Favorable Recommendation I F-91 for all municipal business license questions, contact: City of South Bend a Department of Community Investment OAIZ❑ 227 West Jefferson Blvd • Suite 140DS -South Bend, Indiana 46601 • 574.23S. 0 12 • F 574.235.9 21 6/1 LICENSE APPLICATION FOR — TRANSIENT MERCHANT MUNICIPAL CODE SECTION - 4-60 I. APPLICATION TYPE Check One: BUSINESS DATA New Renewal A. Name of Event: PRIME HOUSE DIRECT TRUCKLOAD MEAT SALE Business Name: COUNTRY FRESH FARMS C. Business Address:5081 UNION ST Ic City:UNION CITY State_GA Zip 30291 Mailing Address (if differs): 10 CELEBRATION WAY City:PEACHTREE CITY 5tate:GA Zip. 30269 E. Business Telephone Number: 912 282 3100 F. Business Fax Number: NIA G. E-Mail Address: FORD@THEPRIMEHOUSEDIRECT.COM R. Indiana State Retailer License number: 0164546561 1. Proposed location where business will be conducted. 4640 S. St Joseph St, South Bend 1. Description of building or prernises to be used: MENARDS PARKING LOT K. Proposed Dates of Operation: L. Proposed Hours of Operation: $AM-7PM M. Types of goods to be sold: USDA FROZEN MEAT SALE N. Scales will be used in business transactions: Yes Nox If yes, please attach certificate from the Sealer of Weights and Measures. 0. Food will be served in ready -to -eat condition: Yes No x P. Description of nature of proposed advertising: SOCIAL MEDIA For Office Use Only Application Filed AUG 0 6 2025 _Public Works Approval Application Fee Paid_AUG0 6 2025 License Fee Paid AUG 0 G 2095 Sent to Dept. AUG fl 6 2095 License Number'T 60 r Not Approved Reason CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS tjl�(4 Elizabeth A. Maradik, President �� Gfs�liit� Gary A. Gilot, Member Murray L. Miller, Member 1/1Z ff t Joseph R. Molnar, Vice President Breana Micou, Member h f 41d1&- Attest: Hillary R. Horvath, Clerk Date: August 26, 2025 For all mumciaal nunness reense Quest ons, contact my of south Bend • Departnent of community Investment M West Jefferson BNE • Suite 1400 S -South Send, Indiana 46631 •51A235.5912 • F. 574,235.9021 LICENSE APPLICATION FOR —TRANSIENT MERCHANT MUNICIPAL CODE SECTION - 4-60 II. BUSINESS DATA(Continued) 0, Contact person to be responsible for customer complaints and available at least sixty(60) days following last date of business: Contact's Legal Name: HARRY PEADEN Residential Address: 10 CELEBRATION WAY City:PEACHTREE CITY State:GA Zip: 30269 Telephone Number: 912 282 3186 III. PERSONAL DATA (Applicant) A. Applicant's Legal Name: HARRY PEADEN B. Residential Address: 10 CELEBRATION WAY City:PEACHTREE CITY State:GA rp: 30269 C. Residential Telephone Number: 912 282 3186 D. Cellphone Number: 912 282 3186 E. Position with business: OWNER 1- IV. PERSONAL DATA (Owner, if differs) A. Owner's Legal Name: SAME AS ABOVE C. Residential Telephone D. Cellphone Number: _ E. Position with business: F. Social Security Number H. Date of birth: For all municipal business (trine questions, mntac : City of South Bend • Department of Community Investment 227Wertlefferaon Blvd -Suite 140 S•South Bend, Indiana 46601• 574.235.5912• F. 574.235.9021 LICENSE APPLICATION FOR -TRANSIENT MERCHANT MUNICIPAL CODE SECTION - 4.60 V. PERSONAL DATA (Additional Owner, if applicable) A. Owner's Legal Name: B. Residential Address: City: State: Zip: C. Residential Telephone Number: D. Celephone Number: E. Position with business: F. Social Security Number. G. Gender: H. Date of birth: I. Race: VI. INCLUDE $5.00 PROCESSING FEE WITH APPLICATION VII. INCLUDE NAMES, ADDRESSES, AND TELEPHONE NUMBERS OF ALL GROUP EVENTPARTICIPANTS. VIIl. INCLUDE A CURRENT CERTIFICATE OF LIABILITY INSURANCE WITH THE CITY OF SOUTH BEND LISTED AS THE CERTIFICATE HOLDER. I%. AFFIRMATION I, hereby, certify and affirm that all of the Information I have given in this application is true and accurate to the best of my knowledge. I further certify that I have in no way attempted to mislead the City in this application by omitting facts known to me. I understand that the completed application must be filed no later than thirty days before the planned event is to begin. I have read and understand the regulations of the Transient Merchant license found in the City of South Bend Municipal Code, Section 4-60. 8/1/25 Signature Date 3 G EORGIA& serve nL •I:J OIiOM a�giMeu�rn�n •ar�r. vvn Michelle Adams From: Michelle Adams Sent: Tuesday, August 5, 2025 11:32 AM To: Cori Ford Subject: RE: CFF MEAT SALE - SOUTH BEND, IN Good morning, Just a friendly reminder that the application Is not complete until the COI and payment have been received; this means the application will not be submitted to the Board of Public Works (BPW) until said items are received. Section 4-60(c) of the South Bend Mun lcipal Code states the following, "Completed forms must be filed no later than thirty (30) days prior to the first date on which the applicant intends to do business." Unfortunately, the BPW will not be able to make their recommendation in time for the proposed date of Sept. 3, 2025. Would you like to change the proposed dates of operation? Please let me know if you have any questions. Bert, - — .11tf4cheile Adams 0J City of South Bend Business License Administrator Department of Community Investment v, 227 W. Jefferson Blvd., Suite 1400 S. South Bend, IN 46601 (574)235-5912 From: Cori Ford <ford@theprimehousedirect.com> Sent: Friday, August 1, 2025 9:56 AM To: Michelle Adams <madams@southbendin.gov> Subject: Re: CFF MEAT SALE - SOUTH BEND, IN Good morning, See attached. I have requested a current COI and retail certificate On Thu, Jut 31, 2025 at 11:05 AM Michelle Adams <madams@southbendinpov> wrote: Good morning, Please find attached the Transient Merchant license application and general instructions. The application must be submitted at least 30-days prior to the event so the Board of Public Works has time to review the application. 1 must also have a Certificate of Liability Insurance with the City of South Bend listed as the Certificate Holder. Said policy shall provide coverage for personal injury, including death and property damage to members of the public in the amount of not less than $300,000.00 per person and $1,000,000.00 per occurrence. The certificate of insurance filed must contain a provision that the City of South Bend, Board of Public Works, shall be given no less than 15 days' notice prior to the effective date of cancellation or material change of the polity. I also attached a copy of the previous year's application. Please let me know if you have any questions. Best, Miche(fe Adams City of South Bend Business license Administrator Department of Community Investment 227 W. Jefferson Blvd., Suite 1400 S. South Bend, M 46601 (574)235-5912 From: Cori Ford <ford@theorimehousedirect.com> Sent: Thursday, July 31, 2025 10:23 AM To: Michelle Adams <madams(@Southbendin.eov> Subject: CFF MEAT SALE - SOUTH BEND, IN Good morning, Country Fresh Farms is planning to return to Menards for our temporary meat sale. It looks like from our notes there was a public works board meeting necessary for us to receive approval. Can you please tell me when the next meeting is so we can schedule our sale accordingly? Also, can you email me a blank application? CAUTION: This email originated from outside of the City of South Bend's network. Do not click links or open attachments unless you validate the sender and know the content is safe. Please report any suspicious emails to the CyberSecurity team by clicking the Phish Alert Button in Outlook. ..n,TF� REGISTERED RETAIL MERCHANT CERTIFICATE INDIANA DEPARTMENT OF REVENUE `J `= 100 N SENATE AVE INDIANAPOLIS IN 46204-2253 ieie (317) 232-2240 COUNTRY FRESH FARMS FEIN 81-3701848 5081 UNION ST LOC ID 0164546561-001 UNION CITY GA 30291-1439 ISSUED October 30, 2024 EXPIRES November 30, 2026 IS AUTHORIZED TO COLLECT INDIANA RETAIL SALES TAX AT THE ADDRESS ABOVE IF DIFFERENT FROM BELOW. THIS LICENSE: IS NOT TRANSFERRABLE TO ANY OTHER PERSON. IS NOT SUBJECT TO REBATE. IS VOID IF ALTERED. 111111111111111111111111111111111111111111111111111111111111111111 IN COUNTRY FRESH FARMS INCORPORATED ° 10 CELEBRATION WAY PEACHTREE CITY GA 30269-1094 COMMISSIONER MUST BE DISPLAYED BY MERCHANT IN THE LOCATION SHOWN --------------------------------(Cut or Fold Here) -------------------------------- 1?4NextLevel ,a�oRo® CERTIFICATE OF LIABILITY INSURANCE TE (MM/DDIYYYY) 708/01/2025 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Natalie Wohlers NAME: StateFarm JARED MULA STATE FARM HONE Ext : 770-874-3325 FAX No : 770-874-3306 3101 TOWERCREEK PKWY SE STE 650 A° AODRIess: NATALIE.WOHLERS.VAAZAV@STATEFARM.COM INSURERS AFFORDING COVERAGE NAIC # ATLANTA, GA 30339 INSURER A: State Farm General Insurance Company 25151 INSURED INSURER B : INSURER C : COUNTRY FRESH FARMS INC / Prime House Direct INSURERD: 5081 UNIONST INSURER E : UNION CITY GEORGIA 30291 INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR Y Y 91-AP-G472-2 09/15/2020 09/15/2025 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES(Ea occurrence) ccurrrence)$ 500,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L X AGGREGATE LIMIT APPLIES PER: POLICY PRO ❑ LOC JECT OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED �/ NON -OWNED AUTOS ONLY X AUTOS ONLY(par., Y Y C28 2151-All 0-11 H 07/10/2025 07/10/2026 COMBINED SINGLE LIMIT Ea accident $ 500,000 X BODILY INJURY (Per person) $ 500,000 BODILY INJURY (Per accident) $ 500,000 PROPERTY DAMAGE Per accident $ 500,000 COMP/COLL $ 1,000 UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE N/A 91-EF-D903-7F 09/19/2020 09/19/2025 EACH OCCURRENCE $ 2,000,000 ri AGGREGATE $ 2,000,000 DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A 91-MB-E973-5 07/24/2025 07/24/2026 PER OTH- STAT UTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CITY OF SOUTHBEND ACCORDANCE WITH THE POLICY PROVISIONS. 227 W JEFFERSON BLVD AUTHORIZED REPRESENTATIVE SOUTHBEND, IN 46601 ACORD 25 (2016/03) @ 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 1001486 132849.12 03-16-2016