Form Dbpr Hr 7029 – Fill Out and Use This PDF

DBPR HR-7029 – Division of Hotels and Restaurants Application for Temporary Event Vendor License

person who, in accordance with the rules of the issuing agency, is determined to be able directly or indirectly to control the operation of the business of the licensed entity. (Required)

ﾉRouting Name – if correspondence should be mailed to a different name than the owner, please indicate in the space provided. (Optional)

ﾉStreet Address or Post Office Box, City, State, Zip Code, Florida County (if applicable), Country – address of record for purpose of official communications from the department. (Required)

ﾉPhone Number (Required) and Extension (Optional) – primary contact number for questions or concerns about the application.

ﾉE-Mail Address – additional means of contacting applicant. (Optional)

ﾉFax Number (Alternate phone number) -- additional means of contacting applicant. (Optional)

Section 4 – Establishment Information

Doing Business As (DBA) Name – Please indicate the name of the establishment doing business as (for example, Mike’s Gyros).

Section 5 – Event Sponsor Information

ﾉSponsor Name – Individual or organization that is organizing this temporary event.

ﾉSponsor Telephone – Contact number for the indicated sponsor.

Section 6 – Event Information

ﾉEvent Name – Name of event (for example, Anytown Seafood Festival).

ﾉEvent Address – Location of the Event (for example, Any County Fairgrounds).

ﾉEvent City – City name where the event is located.

ﾉOpen Date – Month/Date/Year - that participation at the indicated event begins.

ﾉEnd Date – Month/Date/Year - the last day of participation at the indicated event.

ﾉHours of Operation – Exact time of day when food preparation will begin for the event and time of day participation at the event will end. (for example, 8 AM until 11 PM) The event may not open until 10 AM; however, you begin setting up your operation at 8 AM.

Section 7 – Signature

Please print name and title, sign and date the application before submitting. (Required)

LICENSE FEES

Fees for temporary event vendor licenses are as follows:

1-3 day event	$91
4-30 day event	$105
Annual license	$1,000

The division does not accept cash payments, or personal or business checks for temporary event vendor fees. The division will only accept cashier's checks, money orders, or other certified payments.

FOR 1-30 DAY TEMPORARY EVENTS, please present the completed application, documentation and required fee(s) to the inspector on site at the temporary event.

FOR APPLICATIONS FOR ANNUAL TEMPORARY EVENT LICENSES, complete this application and call the Customer Contact Center at 850.487.1395 to request an “opening” inspection. An inspector will be in contact within 5 business days to schedule the inspection. Please have the completed documentation and all required fee(s) ready for the inspector at the inspection.

All vendors are required to meet the sanitation and safety standards provided by law. Unless otherwise approved by the division, these standards include the provision that food employees may not contact ready-to-eat foods with their bare hands immediately prior to service and shall use suitable utensils such as deli tissue, spatulas, tongs, single-use gloves, or dispensing equipment.

2008 March 11

www.MyFloridaLicense.com/dbpr/HR

61C-1.002, FAC

Page 2 of 3

DBPR HR-7029 – Division of Hotels and Restaurants Application for Temporary Event Vendor License

STATE OF FLORIDA

DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION

Phone: 850.487.1395 Email: Call.Center@dbpr.state.fl.us

www.MyFloridaLicense.com/dbpr/hr/

SECTION 1 – TEMPORARY EVENT VENDOR TYPE (2016)

	SECTION 2 – APPLICATION INFORMATION
	Current DBPR Food Service License Number		* Under the Federal Privacy Act, disclosure of Social
			Security Numbers is voluntary unless specifically
	(if applicable)
			required by Federal statute. In this instance, disclosure
			of social security numbers is mandatory pursuant to
	Federal Employers Identification Number (FEIN)
			Title 42 United States Code, Sections 653 and 654; and
	(For businesses and corporations)		sections 409.2577, 409.2598, and 559.79, Florida
			Statutes. Social Security numbers are used to allow
	Social Security Number* (REQUIRED)		efficient screening of applicants and licensees by a Title
			IV-D child support agency to assure compliance with
	(For president, primary shareholder, partner or individual)
			child support obligations.

SECTION 3 – MAILING INFORMATION

Note: This address will be designated as the "address of record" for purpose of official communication from the department.

	Owner Name (please check one:	Corporation	Partnership	Individual)	FOR ESTABLISHMENTS OWNED OR OPERATED BY
					PARTNERSHIPS, CORPORATIONS OR COOPERATIVES,
					please attach a separate sheet or sheets listing the name,
	Routing Name (complete only if correspondence should be mailed to a different				address, and social security number of each person who owns
	person or company than the owner name listed above)				10% or more of the outstanding stocks or equity interest in the
					licensed activity and the name, address, and social security
					numbers of each officer, director, chief executive, or other
					person who, in accordance with the rules of the issuing agency,
	Street Address or Post Office Box
					is determined to be able directly or indirectly to control the
					operation of the business of the licensed entity.

SECTION 4 – ESTABLISHMENT INFORMATION

Doing Business As Name (DBA)

SECTION 5 – EVENT SPONSOR INFORMATION

SECTION 6 – EVENT INFORMATION

Event Name

Event Address

Event City

Open Date	End Date	Hours of Operation

SECTION 7 – SIGNATURE

SECTION 559.79 (2), FS: Each application for a license or renewal of a license issued by the Department of Business and Professional Regulation shall be signed under oath or affirmation by the applicant, or owner or chief executive of the applicant without the need for witnesses unless otherwise required by law.

I certify that I am empowered to execute this application as required by section 559.79, FS. I understand that my signature on this application has the same legal effect as if made under oath. To the best of my knowledge, all information contained on this application is true and correct. I understand that falsification of any information on this application may result in administrative action, including fines up to $1,000, suspension or revocation of the license.

	Applicant Name	Applicant Title

2008 March 11

www.MyFloridaLicense.com/dbpr/hr

61C-1.002, FAC Page 3 of 3