N.M. Admin. Code § 9.4.5.41
APPENDIX C
PERMIT FOR THE ESTABLISHMENT OF A VENDING FACILITY ON FEDERAL PROPERTY AS AUTHORIZED BY PUBLIC LAW 74-732, AS AMENDED BY PUBLIC LAW 83-565 AND TITLE II OF PUBLIC LAW 93-516 (RANDOLPH-SHEPPARD ACT)
The New Mexico Commission for the Blind of the State of New Mexico requests approval of _____________________ to place a vending facility on the property located at ______________
Satisfactory Site: It has been determined that this location meets the criteria of a satisfactory site as defined in 34 CFR 395.1(q). Any exceptions are documented in Attachment A.
Type, Location, and Size of Facility: Type of facility: _______________________ Facility location:________________________ Facility Size:___________________________ (floor plan, Attachment B). The type of articles to be sold and services to be offered are enumerated including the responsibility for the provision thereof, are set forth in Attachment D. The location, type, and number of vending machines which constitute all or part of this facility are noted in Attachment E. The facility will operate ________ days of the week from __________ a.m. to __________ p.m. commencing on _____________________.
Machine Income Sharing: The type and location of each vending machine located in this property and the specific income sharing provisions in 34 CFR 395.32 applicable to each such machine will be indicated in Attachment F. Vending machine income will be disbursed to the commission for the Blind on at least a quarterly basis, or as otherwise agreed.
Other Terms and Conditions: Both parties must comply with 34 CFR 395.35. Any additional terms and conditions applicable to this location are in Attachment G. This permit is issued for an indefinite period of time subject to suspension or termination for noncompliance by either party with any of the agreed upon terms and conditions of the permit. By mutual agreement, the commission for the Blind and the property agency/owner may terminate the permit after providing notice of the intended termination, including the reason for it and supporting documents, to the other party. Both parties must comply with all regulations issued in Title VI of the Civil Rights Act of 1964. The reason for denying the application must be sent in writing to the New Mexico Commission for the Blind.
_____________________________ ______________________________
Approving Property Official Commission for the Blind
_________________________________ _________________________________
Title Date Title Date
Appendix C, Page 2
PERMIT FOR VENDING FACILITY
ATTACHMENT A
SATISFACTORY SITE EXCEPTIONS
Appendix C, Page 3
PERMIT FOR VENDING FACILITY
ATTACHMENT B
FLOOR PLAN OF PROPOSED VENDING FACILITY
Appendix C, Page 4
PERMIT FOR VENDING FACILITY
ATTACHEMENT C
TYPES OF ARTICLES AND SERVICES TO BE OFFERED
Appendix C, Page 5
PERMIT FOR VENDING FACILITY
ATTACHMENT D
FIXTURES AND EQUIPMENT
Appendix C, Page 6
PERMIT FOR VENDING FACILITY
ATTACHMENT E
VENDING MACHINES WHICH ARE PART OF THIS VENDING FACILITY
Description:Location:Number:
Appendix C, Page 7
PERMIT FOR VENDING FACILITY
ATTACHMENT F
COMPETING VENDING MACHINES - INCOME SHARING (COMMISSIONS)
Appendix C, Page 8
PERMIT FOR VENDING FACILITY
ATTACHMENT G
OTHER TERMS AND CONDITIONS
N.M. Admin. Code § 9.4.5.41