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Form 3610 -Temporary Food Service Events Vendors

  1. **Incomplete applications will not be processed**
  2. Instructions
    In order to operate at a temporary/special event in Jefferson County, you must obtain approval from this department. Vending at a temporary/special event may not require a license if you are a mobile unit licensed through the State of Colorado, are a registered wholesaler, Cottage Food vendor, or serve exempted foods. Please contact Michael Lucero at 303-230-7093 or at mjlucero@jeffco.us if you are unsure if a license is required. Applications must be submitted 14 days prior to your first event. Approvals cannot be guaranteed on any applications submitted after this time period.
  3. Payment Instructions
    Payment can be made by cash, check or credit card. If paying by credit card, we will contact you to process once your application is approved. Make checks payable to: Jefferson County Treasurer Mail to: Jefferson County Public Health 645 Parfet Street Lakewood, CO 80215
  4. License Fee - Temporary Vendor (Full Food Service)
  5. License Fee - Temporary Vendor (Pre-packaged)
  6. Payment Type
  7. **You must have your license in your booth at all times**
  8. Commissary Agreement
  9. If you already have a commissary agreement form a local health department, please upload it below. Otherwise, please complete the Jefferson County commissary agreement.
  10. Once completed, the commissary agreement must be uploaded to this online application.
  11. VENDOR DETAILS
  12. Will you be operating more than one booth at the same time?*
    Example: You will be at 2 separate events at the same time on the same day or 2 booths that are not connected at the same event. NOTE: You must have a separate Jefferson County License for EACH booth you operate.
  13. List all events that you will participate in and the dates.
    NOTE: If you are attending more than 1 event on the same date you must have a separate Jefferson County License for each event you are attending.
  14. Please list all food products and the source (grocery chain, wholesaler, etc.). Be sure to include items such as toppings, condiments and ice. All food items must be from an approved source — no home-made or home-processed foods (including ice) ar permitted. Please separate items as in the following example: Grade-A eggs - King Soopers; Hamburger buns - Whole Foods;
  15. 2) Food Preparation Before The Event
    All slicing, chopping, peeling, dicing, shredding, mixing and pre-washing must be done at an approved commissary. Food prep is NOT allowed to take place at the event. Food may not be cooked or stored at home. Please complete this section AND the Affidavitt of Commissary.
  16. Cooling of Foods (that have been previously cooked)
    List specific foods to be cooled below. Foods must be rapidly cooled to 41°F or below. Cooling methods may include: Shallow pans (less than 4") in refrigerator or cooler, Ice paddle or wand, Using an ice-bath, or Other.
  17. Reheating of Foods
    List specific foods to be reheated below. Foods must be re-heated to at least 165 °F. Reheating methods may include: Microwave oven, Conventional oven, Hot plate, Grill, or Other.
  18. Food Transportation*
    What equipment will you use to control food temperatures during transport from the commissary to the event? (Check all that apply) NOTE: Containers/coolers made from Styrofoam are not approved for use.
  19. 3) Food handling at the event
    NOTE: Unwrapped food on display must be properly covered or protected by sneeze guards.
  20. How will hot foods be cooked to the minimum required temperature at the site? (Check all that apply)*
  21. How will hot foods be held at 135 °F or greater at the event? (Check all that apply)*
    NOTE: Equipment utilizing fuel-gel canisters (i.e. Sterno®) are NOT allowed at Temporary Events.
  22. How will cold foods be held at 41 °F or below at the event? (Check all that apply)*
  23. What type of food thermometer (0-220 °F) do you have?*
  24. NOTE: Appropriate test strips will be required on-site
  25. Where will utensil washing take place?
    NOTE: On-site washing in tubs/basins is NOT allowed, extra utensils must be provided so soiled items can be changed at a minimum of every four (4) hours.
  26. Where will potable water be obtained?
  27. Where will wastewater be disposed?
    Wastewater shall NOT be dumped on the ground or into storm sewer drains. Wastewater must be dumped in an approved receptacle or sanitary sewer.
  28. HAND WASHING AND FOOD HANDLING AT THE EVENT
  29. NOTE: Hand washing facilities must be located immediately adjacent to any/all food handling areas
    A hand washing station WITHIN each booth or unit is REQUIRED unless only prepackaged foods requiring no preparation and/or cooking are to be served. Please not the new regulation that requires that "A basin that is capable of capturing hand washing wastewater and conveying it into a closed wastewater container shall be provided.
  30. How will you prevent bare hand contact with ready to eat foods?*
  31. Please check the space below that applies to your booth/unit:
  32. Acceptable Hand Washing Station Components:
  33. field sink
  34. hand washing station
  35. BOOTH LAYOUT
  36. Please include the layout of the Temporary Food Establishment/Booth. Please identify and describe all equipment. The layout should include the following (if applicable):
  37. Electronic Signature Agreement*
    By checking the "I agree" box below, you agree and acknowledge that 1) you will operate in accordance with the Colorado Retail Food Establishment Rules and Regulations and will immediately correct any violations found during an inspection, 2) your original Jefferson County license will be posted, and 3) you understand that your license to operate may be suspended or revoked for non-compliance with these requirements and you may be removed from the event.
  38. 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.
  39. Leave This Blank:

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