Florida Commissary Letter Of Agreement Form PDF Details

A Florida commissary letter of agreement is a formal document that outlines the terms and conditions of a business relationship between two or more parties. It may be used in a variety of contexts, such as the sale of goods or services, the exchange of information, or the execution of a contract. A well-crafted letter of agreement can help to ensure that all parties are on the same page, and it can minimize misunderstandings and potential disputes down the road. If you're considering entering into a business arrangement with someone, it's important to have a clear understanding of what's involved. A well-drafted letter of agreement can help to make sure that everything is spelled out upfront.

QuestionAnswer
Form NameFlorida Commissary Letter Of Agreement Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namescommissary lease contract, commisary letter of agreement florida, dept of ag fillable pdf for commissary, commissary agreement letter florida

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Florida Department of Agriculture and Consumer Services

Division of Food Safety

COMMISSARY LETTER OF AGREEMENT

Bureau of Food and Meat Inspection 3125 Conner Boulevard C-26 Tallahassee, FL 32399-1620 (850) 245-5520

ADAM H. PUTNAM

COMMISSIONER

This form is to be filled out and given to the FDACS inspector in the field and submitted as part of a mobile food establishment permit application or with a package ice plant self-vending permit application that requires a commissary.

SECTION 1– MOBILE FOOD ESTABLISHMENT (MFE) OR SELF VENDING ICE UNIT (SVIU) INFORMATION

 

 

Owner Name

 

 

 

 

 

 

 

 

 

Phone Number (include area code)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Owner Mailing Address

 

 

 

 

 

 

 

Permit Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City

 

 

 

 

 

Zip Code (+4 optional)

 

County

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I hereby certify the provided information is correct and understand permit approval is contingent upon verification of an approved commissary.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Print Name (Owner of MFE or SVIU)

 

 

 

 

Signature (Owner of MFE or SVIU)

 

 

 

Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SECTION 2 – PRIMARY COMMISSARY INFORMATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Primary Commissary Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Commissary Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City

 

 

 

 

 

Zip Code (+4 optional)

 

County

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Primary Phone Number (include area code)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Commissary License/Permit Number

 

 

Primary E-Mail Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Licensed By

 

Department of Agriculture & Consumer

 

Department of Business and

 

Department of Health

 

None

 

 

(check one)

 

Services

 

 

 

Professional Regulation

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Water Supply of Primary

 

Municipal/Utility

 

Supplier Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Commissary

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

On-site Well

 

 

Permit Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Municipal/Utility

 

Supplier Name

 

 

 

 

 

 

 

Wastewater Disposal of

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Septic Tank System

 

Permit Number

 

 

 

 

 

 

 

Primary Commissary

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Package Plant

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I intend to provide the following activities at this commissary:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Dish or equipment washing

 

Yes

No

 

 

Storing of food and dry goods (room temperature)

Yes

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Dumping wastewater

 

 

 

Yes

No

 

 

Cold Storage of food (including ice and drinks)

Yes

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Receiving potable water

 

Yes

No

 

 

Cooking and/or reheating food

 

 

Yes

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Washing the outside of the vehicle

 

Yes

No

 

 

Three compartment sink

 

 

Yes

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Restroom facilities

 

 

 

Yes

No

 

 

Other (Describe below)

 

 

Yes

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Describe other activities here:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Signing this document will allow FDACS Food Inspectors entry to my business during normal hours of operation for evaluation of facilities.

 

 

 

 

 

 

 

 

 

 

 

 

Print Name (of Person in Charge of Commissary)

 

 

Signature (of Person in Charge of Commissary)

 

Date

 

 

 

 

 

 

 

 

 

 

 

Are additional commissaries used?

Yes

No

If yes use as many pages as needed.

 

 

 

 

 

FDACS-14223 Rev. 10/15

 

 

 

 

 

 

 

 

 

 

 

 

Page 1 of 1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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1. Complete the letter of online agreement with a group of major fields. Collect all of the necessary information and ensure absolutely nothing is forgotten!

Step # 1 for completing dept of ag fillable pdf for commissary

2. The subsequent part would be to fill in the following fields: Licensed By check one, Department of Agriculture Consumer, Department of Business and, Services, Professional Regulation, Department of Health, None, Water Supply of Primary Commissary, MunicipalUtility, Supplier Name, Onsite Well, Permit Number, MunicipalUtility, Supplier Name, and Wastewater Disposal of Primary.

Licensed By check one, Supplier Name, and Department of Agriculture  Consumer of dept of ag fillable pdf for commissary

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