Title

Temporary Food License application

Sections

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Applications must be submitted to the City of Bloomington at least 10 working days before the event.

Food events at schools require a school permit.

Applicant info

Applicant first name

Applicant last name

Applicant address

Address 2

Applicant city/town

Applicant state

Applicant zip code

Applicant phone

Applicant email

Business name (DBA)

On-site person in charge of food service at event

On-site person email address

On-site person phone number

Do you hold a Retail Mobile Food Handler License from the MN Dept. of Agriculture?

Yes

No

Please provide your Retail Mobile Food Handler License Number:

Is this a food truck?

Yes

No

Event info

Name of event

Event organizer

Event address

Location name

Event city

Event state

Event ZIP/postal code

Event start date

Event end date

Food service start time

Food service end time

Is this event open to the public?

Yes

No

How many people are expected?

Is there an event admission fee?

Yes

No

When will food be prepared?

What time will food arrive at the event?

Will there be a tent greater than 200 square feet or a canopy greater than 400 square feet?

Yes

No

Will alcohol be served at the event?

Yes

No

What is the the name of the liquor caterer?

Liquor caterers must complete the catering event notification at least seven days in advance of the event.

Food info

Complete the chart below for all food and beverages to be served. Add additional pages if needed. Food must be from a commercial source. Home-prepared foods are not allowed. Slowcookers/crock-pots are not allowed. Mechanical refrigeration and hot holding equipment are required for events lasting longer than four hours. The MN Dept of Health collects a statewide hospitality fee for all food, beverage and lodging facilities each year which funds statewide program development activities. Temporary food event license holders are required to pay that fee. Bills are usually sent in the summer for licenses held in the previous calendar year.

More information is available from the Minnesota Department of Health.

Re-order	Hot food name:	Hot food purchased from:	Hot food preparation location:	Equipment used to keep food hot (above 135 degrees F):	Equipment used to cook/heat food:	Weight	Operations
	Hot food name:	Hot food purchased from:	Hot food preparation location:	Equipment used to keep food hot (above 135 degrees F):	Equipment used to cook/heat food:	Item weight

more items

Re-order	Cold food name:	Cold food purchased from:	Cold food preparation location:	Equipment used to prepare food:	Equipment used to keep food cold (below 41 degrees F):	Weight	Operations
	Cold food name:	Cold food purchased from:	Cold food preparation location:	Equipment used to prepare food:	Equipment used to keep food cold (below 41 degrees F):	Item weight

more items

Re-order	Shelf stable food and beverages name:	Shelf-stable food and beverages purchased from:	Shelf-stable food and beverages food preparation location:	Equipment used to prepare shelf-stable food and beverages:	Weight	Operations
	Shelf stable food and beverages name:	Shelf-stable food and beverages purchased from:	Shelf-stable food and beverages food preparation location:	Equipment used to prepare shelf-stable food and beverages:	Item weight

more items

Food safety

Where will food be stored prior to the event?

What facilities will be provided for dishwashing? (if applicable)

What single-service utensils will be used?

What toilet facilities will be provided for food handlers?

Employees must be able to wash their hands with warm running water and liquid hand soap. Paper towels must provided to dry hands. Hand sanitizer is not a substitute for hand washing.

What handwashing facilities will be provided in the stand?

Hand-washing sink

Container with spigot filled with warm water

How will you eliminate direct hand contact with ready to eat foods? (gloves, utensils, etc.)

What sanitizer will be provided to wipe down food contact surfaces and sanitize utensils?

Provide test strips for the chemical you choose. Test strips can be purchased online.

Chlorine (bleach) 50-200 ppm

Quaternary ammonium 200-400 ppm

Not applicable (no food handling or only prepackaged food)

Signature

By signing below, you agree to the following:

Based on the information provided herein, I understand that a temporary food license is required for this event. I further understand that my application will be considered only for the food and beverage specified. The environmental health specialist must be advised of any deviations or changes to the menu.

Signature

Typing your name will serve as your legal signature.

Attachments

Please upload any relevant documents.

Maximum 3 files.
100 MB limit.
Allowed types: txt rtf pdf doc docx odt ppt pptx odp xls xlsx ods.

Math question (3 + 3 =)

Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.

This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.

Please take notice that any data received by the City as the result of submitting this form will be classified as government data pursuant to the Minnesota Government Data Practices Act, Minnesota Statutes Chapter 13. Under the Data Practices Act, some or all of this data is classified as public data, including your name, address, email address, phone number, and other personal information provided by you. Public data is available to anyone requesting it and consists of all data furnished via this Web form. Please be advised that the correspondence will be added to the public record. The purpose and intended use of the information collected through this form is to obtain public input and data in support of City activities and services. You have the right to refuse to submit this form. If you choose not to submit this form, you will need to contact the City by another means if you wish to provide the information collected by the form.

The City of Bloomington does not discriminate against or deny the benefits of its services, programs, or activities to a qualified person because of a disability. To make a request for a reasonable accommodation, ask for more information, or to file a complaint, contact the Community Outreach and Engagement Division, City of Bloomington, 1800 West Old Shakopee Road, Bloomington, MN 55431- 3027; 952-563-8733, MN Relay 711.

Contact Information

City Clerk's Office

952-563-8728

Email staff