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

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

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

6. 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.

8. Form 3600
   Download

   If you wish to complete a paper application instead of this online form, please download the form and send to the address or email noted above.

9. 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.

11. Application Fee*

    1. $95 - Complete applications received by this office 30 days or more before the event
    2. $125 - Complete applications received by this office 29 days or less before the event
12. Payment Type*

    1. Cash (in-person at office)
    2. Check (mail to JCPH)
    3. Credit Card (We will contact you to process once your application is approved)
16. 1) EVENT INFORMATION
18. Event Name*
19. Event Date(s)*
21. Event Location (Physical Address)*
22. City*
24. Hours of Operation (Days and times):*
26. Expected peak attendance:*
    (Max number of attendees at one time)
27. Expected peak day(s) if event is longer than 1 day:
29. Event Coordinator's Name:*
31. Phone Number*
33. E-mail Address*
35. Contact person during the event (if different from above):
36. Phone Number
40. 2) SERVICES PROVIDED TO FOOD VENDORS
42. Check all that apply
44. Water Supply*

    1. There is access to potable water taps on site
    2. Vendors must bring their own water supplies
46. Electricity*

    1. No electricity supplied on site
    2. Access to electricity on site
    3. Generators will be provided for vendor use
    4. Vendors are allowed to use generators on site
48. Wastewater*

    1. There will be liquid waste collection tanks/receptacles on site
    2. Vendors must arrange for their own wastewater disposal
50. Trash/Refuse*

    1. Public trash receptacles provided throughout the event
    2. On site dumpsters for vendors and public trash removal
52. Toilet Facilities*

    1. Public restrooms
    2. Portable toilets

    Ensure portable toilets are serviced at least once after the vent or more often, if necessary.

54. How many (fixtures)?*
55. How many portable?*
57. Hand washing facilities*

    1. Public restrooms
    2. Portable hand wash stations (Must be equipped with soap and paper towels at all times)

    Ensure they are serviced as frequently as is needed to maintain cleanliness.

    
    

59. How many portable hand washing stations?*
60. How many public restrooms?*
62. Other services*

    1. Refrigerated truck(s)
    2. Commissary kitchen
    3. Ice
    4. N/A
66. 3) LIST OF FOOD VENDORS
68. 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 may be required to immediately cease operations! **Note: All coordinators are responsible for ensuring ALL vendors are properly licensed.

69. List of Vendors

    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.

71. Vendor Name
72. Operator Name
73. Operator Phone
74. Email
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111. Additional list of food vendors:
115. 5) TERMS AND CONDITIONS OF APPLICATION
117. 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.

     1. I agree.
119. Electronic Signature*
121. 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.
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123. 1. Receive an email copy of this form.
124. Email address

     This field is not part of the form submission.

125. Submit

* indicates a required field