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Form 3600 - Temporary Food Service Events Coordinators

  1. **Incomplete applications or applications without payment will not be processed**
  2. Contact Information

    Mailing Address: Jefferson County Public Health (JCPH), 645 Parfet Street, Lakewood, CO 80215.

    Contact Information: (303) 232-6301 or [email protected]

  3. Instructions

    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. If you’re unsure if your temporary/special event requires a Certificate of Approval, please contact us at the number above and ask for a Temporary Food Service (TFS) team member, or email us.

    Applications must be submitted 30 days prior to the event start date. 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; additional vendors will NOT be allowed after this time.

  4. Payment Instructions

    Payment can be made by cash, check or credit card. If paying by credit card, we will contact you to process your payment once your application is approved. Make checks payable to Jefferson County Treasurer. If mailing in a check, mail to the address noted above.

  5. Application Fee*
  6. Payment Type*
  7. 1) EVENT INFORMATION
  8. (Max number of attendees at one time)
  9. 2) SERVICES PROVIDED TO FOOD VENDORS
  10. Check all that apply
  11. Water Supply*
  12. Wastewater*
  13. Electricity*
  14. Trash/Refuse*
  15. Toilet Facilities*
  16. Hand washing facilities*
  17. Other services*
  18. 3) TEMPORARY FOOD SERVICE EVENT SITE MAP
  19. Provide a labeled map of the entire Temporary/Special Event area and include the following:
  20. 4) LIST OF FOOD VENDORS
  21. 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.
  22. You may also upload a list of vendors here. Please include the vendor name, operator name, operator phone and email.

    Examples of an approved mobile license and approved temporary vendor license can be found on page 5.

  23. 5) TERMS AND CONDITIONS OF APPLICATION
  24. 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.

  25. Information submitted on this form will be sent via unsecured email. To protect sensitive information, do not enter the following items or similar information on this form: Social Security numbers, driver’s license numbers, bank account information, routing numbers, credit card numbers, medical information, passport numbers, and passwords. Please review our privacy policy located at www.jeffco.us/privacy. By submitting this form, you acknowledge and accept the terms listed in the privacy policy.
  26. Leave This Blank:

  27. This field is not part of the form submission.