Certified Local Application

Step 1 of 4

We are currently accepting applications from all sit-down restaurants within Larimer County. We recommend having your 2019 food purchases from local producers available for the completion of this application. It may help to organize your food purchases by category: produce, meat/fish, dairy, beer and spirits, wine, and honey and other processed foods (spreadables such as jams, mustard; bread; coffee, tea, etc.). All individual business data is kept confidential.
1) Contact Information
Applicant Name*
First Last
Applicant Email*
Applicant Phone Number*
Relation to Restaurant*
2) Restaurant Information
Restaurant Name*
Mailing Address*
Street Address City State / Province / Region ZIP / Postal Code
Website*
Restaurant Phone (if different from above)
Restaurant Email (if different from above)
Restaurant Type*
- Fine Dining
- Casual
- Fast Casual
- Quick Service (counter & drive-through)
Owner Name (if different from above)
First Last
Owner Phone (if different from above)
Owner Email (if different from above)
Restaurant Instagram
Restaurant Facebook

3) Standards & Local Food Purchases
Please report purchases at the individual producer level (not distributor/purveyor)
Are you applying for Core or Exceptional?*
- Core
- Exceptional
Total spent annually on local food purchases:*
Total spent annually on ALL food purchases:*
Fair Marketing: Within the past 30 days, you must have purchased product from every farm listed on your menu, displays, and marketing materials (including website). If you do not update menus monthly, farm names and products must be listed on a chalkboard or other changeable display. Do you agree to the Fair Marketing Standards?*
- Yes
- No
Seasonal Menu: The main ingredients of at least one appetizer and one entree must be entirely locally procured and seasonally appropriate, year round. Do you agree to the seasonal menu standard?*
- Yes
- No
PURCHASING: At all times, all restaurants must offer at least one Colorado-grown or produce item from five (5) of the Certified Local food categories: 1) produce; 2) meat, fish, eggs; 3) dairy; 4) beer & spirits; 5) wine; 6) honey and other processed foods.
CORE STANDARD: Core restaurants must have at least THREE (3) local (Northern Colorado) agricultural products on the menu at any given time. Only items from categories 1), 2), and 3) above satisfy this criterion.
EXCEPTIONAL STANDARD: Exceptional restaurants must have at least SIX (6) local (Northern Colorado) agricultural products on the menu at any given time. Products must include at least two (2) produce items and at least one (1) meat/fish item. Only items from categories 1), 2) and 3) above satisfy this criterion. Additionally, the alcoholic beverage menu must include at least one (1) beverage from two of the three categories (beer, wine, and spirits) for a total of three (3) Colorado beverages.
1. Produce: List all Colorado produce purchases by producer. Click (+) to add additional rows. **Exceptional must list at least TWO (2) Northern Colorado items***
Producer Business Name Producer Contact Name Contact Phone/Email Date of most recent purchase Total Purchases ($) Items Purchased
2. Meat, Fish, & Eggs: List all Colorado meat, fish, and egg purchases by producer. Click (+) to add additional rows. **Exceptional must list at least ONE (1) Northern Colorado item***
Producer Business Name Producer Contact Name Contact Phone/Email Date of most recent purchase Total Purchases ($) Items Purchased
3. Dairy: List all Colorado dairy product purchases by producer. This includes cow, goat, sheep, etc. Click (+) to add additional rows.*
Producer Business Name Producer Contact Name Contact Phone/Email Date of most recent purchase Total Purchases ($) Items Purchased
4. Beer & Spirits: List all Colorado beer and spirit purchases by producer. Click (+) to add additional rows. **Exceptional must include at least one beverage from two of the three categories (beer, wine, and spirits) for a total of three (3) Colorado beverages.***
Producer Business Name Producer Contact Name Contact Phone/Email Date of most recent purchase Total Purchases ($) Items Purchased
5. Wine: List all Colorado wine purchases by producer. Click (+) to add additional rows. **Exceptional must include at least one beverage from two of the three categories (beer, wine, and spirits) for a total of three (3) Colorado beverages.***
Producer Business Name Producer Contact Name Contact Phone/Email Date of most recent purchase Total Purchases ($) Items Purchased
6. Honey and other processed foods: List all Colorado processed food purchases such as honey, spreadables, and drinkables by producer. Click (+) to add additional rows.*
Producer Business Name Producer Contact Name Contact Phone/Email Date of most recent purchase Total Purchases ($) Items Purchased

4) Program Specific Questions
Do we have permission to include your restaurant name and/or logo on the Certified Local Restaurants list and webpage?*
- Yes
- No
Do we have permission to include your restaurant name and tag your restaurant on social media posts, marketing materials, etc.?*
- Yes
- No
Would you be interested in hosting a Certified Local event at your restaurant, such as a cocktail hour, or participating in on-farm events such as tours and dinners?*
- Yes
- No
Answers to the following questions will greatly help us continue to add benefits to the Certified Local program based on restaurant needs.
Why do you choose to support local food producers?
What are your biggest challenges in offering more locally produced food to your customers/on your menu?

5) Logo
Please upload a high-resolution version of your restaurant logo.
Upload logo*
Accepted file types: jpg, png, Max. file size: 256 MB.
6) Audit Permission & Fee
Consent*
I give permission to be audited.
The Northern Colorado Foodshed Project has my permission to perform a spot audit of
the producers and food purchases listed above upon both on receipt of this application and quarterly,
based on what is listed on the restaurant menu, website, marketing materials, and in-store signage.
Method of Payment (to be sent after acceptance)*
- Payment by check
- Payment by credit card
Comments
This field is for validation purposes and should be left unchanged.

Producer Business Name	Producer Contact Name	Contact Phone/Email	Date of most recent purchase	Total Purchases ($)	Items Purchased

Step 1 of 4

1) Contact Information

2) Restaurant Information

3) Standards & Local Food Purchases

4) Program Specific Questions

5) Logo

6) Audit Permission & Fee