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Form 3600 - Temporary Food Service Events Coordinators
This form has been modified since it was saved. Please review all fields before submitting.
**Incomplete applications or applications without payment will not be processed**
If you wish to complete a paper application instead of this online form, please download the form and send to Michael Lucero at firstname.lastname@example.org. For questions, please call 303-239-7093
All Temporary/Special Events in Jeffco that offer food for public consumption must comply with the Department's food safety rules and regulations and receive a Certificate of Approval before operating. Please submit this application no later than 30 days prior to the event. You may pay by check or credit card. If paying by credit card, please submit your application and we will follow-up to process your payment. PAYABLE TO: Jefferson County Treasurer MAIL TO: Jefferson County Public Health 645 Parfet Street Lakewood, CO 80215 You MUST inform this office if vendors are added after your initial submittal of this application. The FINAL list of vendors must be submitted to this office 7 days prior to your event. No addition vendors will be allowed after this time.
$95 - Complete applications received by this office 30 days or more before the event
$125 - Complete applications received by this office 29 days or less before the event
Check (mail to Jeffco Public Health)
Credit Card (We will contact you to process once your application is approved)
Event Location (Physical Address)
Hours of Operation (Days and times):
Expected peak attendance:
(Max number of attendees at one time)
Expected peak day(s) if event is longer than 1 day:
Anticipated number of food booths:
Event Coordinator's Name:
Address Line 2
Contact person during the event (if different from above):
SERVICES PROVIDED TO FOOD VENDORS
Check all that apply
There is access to potable water taps on site
Vendors must bring their own water supplies
There will be liquid wast collection tanks/receptacles on site
Vendors must arrange for their own wastewater disposal
No electricity supplied on site
Access to electricity on site
Generators will be provided for vendor use
Vendors are allowed to use generators on site
Public trash receptacles provided throughout the event
On site dumpster for vendors and public trash removal
How often will trash be serviced?
How many (fixtures)?
How many portable?
How often will be serviced?
Hand washing facilities
Portable hand wash stations (Must be equipped with soap and paper towels)
How many public restrooms?
How many portable hand washing stations?
How often will be serviced?
TEMPORARY FOOD SERVICE EVENT SITE MAP
Provide a labeled map of the entire Temporary/Special Event area and include the following:
Toilet facilities (portable and fixed)
Hand washing facilities
Electrical hook-up points and generator locations
Potable water taps for vendors
Location of all food preparation and service areas on the event grounds
Food booth vendors
Roadways, sidewalks and walkways
Refrigerated truck (if applicable)
Commissary kitchen (if applicable)
Petting zoo (if applicable)
Upload your map here
LIST OF FOOD VENDORS
ALL FOOD VENDORS MUST HAVE A CURRENT JEFFERSON COUNTY TEMPORARY FOOD VENDOR LICENSE OR A COLORADO RETAIL FOOD LICENSE FOR MOBILE UNITS
If a vendor does not have a License they should be instructed to contact Jefferson County Public Health for further information. Unapproved vendors found during inspections will be required to leave the event immediately! **Note: All coordinators are responsible for ensuring ALL vendors are licensed properly.
List of Vendors
You may also upload a list of vendors here. Please include the vendor name, operator name, operator phone and email.
Additional list of food vendors:
TERMS AND CONDITIONS OF APPLICATION
Electronic Signature Agreement
In applying for Approval to Operate a Temporary/Special Food Service Event I hereby state that all information contained in this application is true and correct to the best of my knowledge, including the acceptability of all food vendors I have listed. I will only allow food vendors with a current Jefferson County Temporary Food Vendor License or Colorado Retail Food License for Mobile Units to operate at my event. I agree to operate this temporary event in compliance with all applicable sections of the Colorado Retail Food Establishment Regulations and the terms and conditions imposed by the Department.
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