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2. **Incomplete applications 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

   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’re unsure about your licensing needs, please contact us at the number above and ask for a Temporary Food Service (TFS) team member, or email us. Applications must be submitted 14 days prior to your first event. Approvals cannot be guaranteed on any applications submitted after this time period.

8. Form 3610 (PDF)
   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. License Fee - Temporary Vendor (Full Food Service)

    1. $145 - Complete applications received 14 days or more before the event
    2. $175 - Complete applications received 13 days or less before the event
12. License Fee - Temporary Vendor (Pre-packaged)

    1. $125 - Complete applications received 14 days or more before the event
    2. $155 - Complete applications received 13 days or less before the event
13. Payment Type

    1. Cash (in-person at office)
    2. Check (mail to JCPH)
    3. Credit Card (We will call you once your application is approved)
15. **You must have your license in your booth at all times**
19. Commissary Agreement
21. If you already have a commissary agreement form a local health department, please upload it below. Otherwise, please complete the Jefferson County commissary agreement.
23. 1) Commissary Agreement
    Download

    The commissary agreement must be completed and signed by the commissary operator and initialed by you.

24. 2) Upload Completed Commissary Agreement*
28. VENDOR DETAILS
30. Temporary Retail Food Establishment Name*
32. Operator/Owner's Name*
33. Name of Primary Contact*
35. Establishment Mailing Address (Street address and P.O. Box)*
37. Address Line 2
39. City*
40. State*
41. Zip Code*
43. Phone Number*
45. Email Address*
47. Will you be operating more than one booth at the same time?*

    1. Yes
    2. No

    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.
49. List all events that you will participate in.
51. Event Name*
52. Date*
53. Location*
55. .
56. .
57. .
59. .
60. .
61. .
63. .
64. .
65. .
67. .
68. .
69. .
73. 1) EVENT MENU*

    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.

77. 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.

    1. I will not be processing any food items prior to the event, skip to the next section, 3) FOOD HANDLING AT THE EVENT.
79. 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 (specify below).

81. Food Item #1
82. Cooling Method
84. Food Item #2
85. Cooling Method
87. Food Item #3
88. Cooling Method
90. Food Item #4
91. Cooling Method
93. Food Item #5
94. Cooling Method
98. 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 (specify below).

100. Food Item #1
101. Reheating Method
103. Food Item #2
104. Reheating Method
106. Food Item #3
107. Reheating Method
109. Food Item #4
110. Reheating Method
112. Food Item #5
113. Reheating Method
117. 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.

     1. Coolers with ice
     2. Refrigerator
     3. Cambros for hot foods
     4. Other (specify below)
119. If other, please specify:
123. 3) FOOD HANDLING AT THE EVENT

     NOTE: Unwrapped food on display must be properly covered or protected by sneeze guards.

125. How will hot foods be cooked to the minimum required temperature at the site? (Check all that apply)*

     1. Grill
     2. Hot plate
     3. Microwave
     4. Deep fat fryer
     5. Oven
     6. Other (specify below)
     7. Not applicable
127. If other, please specify:
129. How will hot foods be held at 135 °F or greater at the event? (Check all that apply)*

     1. Hot holding unit
     2. Steam table
     3. Held on grill until served
     4. Held under heat lamps
     5. Crock Pot
     6. Served immediately after cooking
     7. Other (specify below)
     8. Not applicable

     NOTE: Equipment utilizing fuel-gel canisters (i.e. Sterno®) are NOT allowed at Temporary Events.

131. If other, please specify:
133. How will cold foods be held at 41 °F or below at the event? (Check all that apply)*

     1. Refrigerator/freezer
     2. Ice chest (Must be drainable and foods may not be kept in contact with the ice unless they are packaged and sealed. All ice must be commercially manufactured)
     3. Other (specify below)
     4. Not applicable
135. If other, please specify:
137. How will you allow for sufficient ice throughout the entire event?
139. What type of food thermometer (0-220 °F) do you have?*

     1. Metal stem probe
     2. Thermocouple
     3. Digital
     4. Other (specify below)
     5. Not applicable
141. If other, please specify:
143. How will food contact surfaces be cleaned and sanitized at the event? (include sanitizer type - i.e. chlorine or quaternary ammonia - or note N/A)
145. Where will utensil washing take place?

     1. At the commissary
     2. Commercial 3-compartment sink unit (i.e. part of a mobile unit)
     3. Not applicable

     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.

147. If other, please specify:
149. Where will potable water be obtained?

     1. Commissary
     2. On-site source (any hoses used to provide water must be food-grade)
     3. Not applicable
151. If other, please specify:
153. Where will wastewater be disposed?

     Wastewater shall NOT be dumped on the grass, ground or the into streets / storm sewer drains. Wastewater must be dumped in an approved receptacle or sanitary sewer.

     1. Commissary
     2. Approved on-site receptacle at event
     3. Not applicable
155. If other, please specify:
159. 4) HAND WASHING AND PREVENTING BARE HAND CONTACT
161. NOTE: Hand washing facilities must be located immediately adjacent to any/all food handling areas

     Hand sanitizers are NOT an acceptable substitute for a required hand washing station.

163. How will you prevent bare hand contact with ready to eat foods?*

     1. Tongs
     2. Food-grade disposable gloves
     3. 'Deli' tissues
     4. Other (specify below)
     5. Not applicable
165. If other, please specify:
167. Please check the space below that applies to your booth/unit:

     1. I will be serving only prepackaged foods that require no preparation and/or cooking: skip to next section 5) BOOTH LAYOUT
     2. I will be serving foods that require preparation and/or cooking - see below for requirements
169. Hand Washing Station Components (within each booth/unit):
     • Container of potable (clean) water for hand washing
     • Faucet or spigot that provides constant/free-flow of water for two-handed washing
     • Catch basin or container for wastewater 
     • Soap
     • Paper towels
     • Trash can
171. Acceptable Hand Washing Station Components:
173. 
174. 
175. 
176. 
180. 5) BOOTH LAYOUT
182. Please include the layout of the Temporary Food Establishment/Booth. Please identify and describe all equipment. The layout should include the following (if applicable):

     1. Cooking equipment
     2. Hand washing facilities
     3. Food and single service storage
     4. Customer service area
     5. Hot and cold holding equipment
     6. Work surfaces
     7. Garbage or trash containers
     8. Potable water lines
183. Upload your layout:*
185. 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(s) will be posted, and 3) you understand that your license(s) to operate may be suspended or revoked for non-compliance with these requirements and you may be removed from the event.

     1. I agree.
187. Electronic Signature*
189. 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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