University of California, Davis TEMPORARY FOOD FACILITY APPLICATION THIRD PARTY VENDOR

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1 University of California, Davis TEMPORARY FOOD FACILITY APPLICATION THIRD PARTY VENDOR 1 Use this application for sale of prepackaged or prepared food or beverages. Use NonFood Operator Application for sale of nonfood items. DO NOT USE THIS FORM FOR NONFOOD ITEMS OFFICE USE ONLY OFFICE USE ONLY Date received: Received by: EVENT NAME BLACK FAMILY DAY. EVENT DATE MAY 19 TH 2018 EVENT SPONSER CROSS CULTURAL CENTER. RETURN APPLICATION TO LISA PENNES 397 HUTCHISON DRIVE SUITE 1300, DAVIS, CA APPLICATION DEADLINE: MUST BE POSTMARKED BY MARCH 16 th Vendor Fee Liability Insurance (proof enclosed) Auto Insurance (proof enclosed) NOTICE OF FEES: THERE ARE TWO FEES; A STANDARD EVENT FEE PLUS A VENDOR FEE DEPENDING ON WHAT TYPE OF ITEMS YOU ARE SELLING Standard Event fee: $100 Event Fee to all food vendors for participation in this event. Vendor Fees: Option 1: $100 Fee for vendors selling prepackaged goods Option 2: $230 Fee for vendors selling all other prepared food or beverages in 10 x10 booth Option 3: $450 Fee for larger booths up to maximum of 20 x10 NOTICE OF INSURANCE: Proof of business and auto insurance are required. Applications will not be processed without attached proof of insurance. 1) Business/Operator Name: 2) Tax ID Number: (Employer ID or SS#) 3) Business License or Resale Number and Type 4) Business Owner s Name/Contact: 5) Business Address: Mailing Address: City: State: Zip: 6) Telephone Contact: Business Phone: ( ) Cell Phone: ( ) Fax #: ( ) Best time to call: 7) Is this a nonprofit organization? (if yes, please include copies of your federal and state nonprofit, tax exemption status papers with this application) Yes No 8) Who will be on site during event: 9) Address of on site contact: Mailing Address: City: State: Zip: 10) Telephone: ( ) Best time to call:

2 Food Preparation All foods must be stored and prepared in, or purchased from, approved food facilities. If you need clarification, read EH&S Food Safety Requirements, or phone the UCD Office of Environmental Health & Safety at (530) (please use a separate sheet of paper if you need additional space to explain any item below) 11) List your ingredients or prepared foods and provide the following information about the location from which it will be purchased. Food Item Type of Business City, State, & Zip Ex: Chicken Ex: Wholesale Meat Ex: Sacramento, CA Ex: French Fries Ex: Grocery Business Name and Address Ex: Mad Butcher Ex: Costco County or State Health Permit Number Ex: Yolo Co. #F1234 Ex: State Dept. of Health # ) Comments

3 13) List all menu items and their prices, including beverages. Include major ingredients such as canned foods, eggs, dairy products, meat and pasta. You do not need to include flour, salt baking soda etc. briefly describe the manner of foods preparation and service. Only items listed and approved will be allowed for sale at the event. 3 Ex: Food Item: TriTip sandwich $6, dinner $8 Beef TriTip, sandwich roll, seasoning; green salad and Italian dressing Prep & Service: Cut tritip out of sealed bag from ice chest; place on grill; add seasoning; remove to hotholding; remove to hotholding in chafing dish; place prepackaged lettuce mix in ice bath; place salad on dinner plate and add dressing. A. Food Item: B. Food Item: C. Food Item: D. Food Item: E. Food Item:

4 BOOTH SETUP 4 Enclosed tent (minimum 8 x8, maximum 10 x10 ) with four sides, front and back must zip open with flame resistant CPAI84 certified tarp completely covering floor area. You can buy, borrow or rent a tent. Skirting for Front Sales Table Must cover front of table from top to ground and pole to pole Hand washing station on top of table: Must include potable water in 5 gallon container with hands free faucet/spigot; liquid hand soap in a pump dispenser; paper towels; and a catch basin to collect waste water. Hand washing station must be inside tent. Sale/Service Area Table (check with Event Sponsor for how many 8 tables & chairs will be provided). Food preparation table(s). Utensils/Ware washing Station on table: 3 large containers/tubs (WashRinseSanitize); liquid bleach; dishwashing soap, testing strips and an area for airdrying utensils. If the utensil ware washing is outside, overhead protection must be provided. Hot and Cold Electrical Equipment plus one 100ft 12 or 14 gauge electrical cord (not two 50 cords) and surge protected power strip. BBQ / Propane Stove / Open Flame Equipment (including sternos, chafing dish, etc.) Propane tanks must be secured against tipping with milk creates or similar item & located away from traffic areas Ice Chests Pallets/Boxes/Shelves for storing equipment & food at least 6 off the ground prior to usage. Fire Extinguisher (if required, it will be provided by Fire Prevention). Trash Can (provided by event sponsors) Thermometer (provided by event sponsors) Oil/Grease Disposal Container plus Secondary Drip Pan Plastic Disposable gloves (recommended nonlatex) Decorations must be within footprint of tent, structurally sound and fire proofed. 10ft 10ft BBQ 10ft 10ft ICE CHEST HANDWASH STATION 3STEP WARE WASH FIRE RETARDANT TARP ON FLOOR STORAGE SAMPLE PLAN FOOD PREP MONEY SERVING

5 5 BOOTH INFORMATION AND DIAGRAM TEMPORARY FOOD BOOTHS THAT HANDLE UNPACKAGED, OPEN FOODS SHALL PROTECT FOOD BY A FULLY ENCLOSED TENT WITH 16 MESH PER SQUARE INCH SCREENS BACKYARD FIRE RETARDANT TARP ON FLOOR

6 ELECTRICAL NEEDS 6 Operators are responsible for providing all equipment, including: 100 foot long 12 or 14gauge extension cords (shorter cords may not be strung together) Surge protected power strips All equipment and extension cords must be in good working condition, UL Listed and meet campus electrical requirements (see attached Electrical Safety Requirements for Temporary Facilities ). List below EACH item of equipment that requires electricity, propane and/or charcoal. For electrical equipment, you must provide amps OR both volts and watts required for each item. Power is limited and items not identified below will not be permitted. Equipment Volts Watts Amps Propane Other (specify) Ex. Small Refrigerator Burner Steam Table Generator 115v 42w 1.12amp 5 gal Canola Oil Total

7 Please make sure you enclose the following: Proof of business insurance Proof of auto insurance $100 standard event fee $ additional vendor fee ($100 for prepacked goods, $230 for prepared food, $450 for larger booth 20 x10 ) Payment: We accept Cashier s check or Money Order made out to UC Regents Notice: If you are not approved to vend at this event, the full amount of the standard fee and the vendor fee will be returned to the address provided. INDEMNIFICATION Vendor shall defend, indemnify, and hold the University, its officers, employees, and agents harmless from and against any and all liability, loss, expense (including reasonable attorneys fees), or claims for injury or damages arising out of vendor s activities on University premises but only in proportion to and to the extent such liability, loss, expense, attorneys fees, or claims for injury or damages are caused by or result from the negligent or intentional acts or omissions of vendor, its officers, agents, or employees. I have read and understand the information provided to me by the event organizers. I am aware that participation in this event is contingent upon: 1. Provision of all information requested at the time I submit this application; 2. Acceptance of application by event organizers, UC Davis Fire Department, UC Davis Property and Liability, and UC Davis Office of Environmental Health and Safety (EH&S); 3. Adherence to all guidelines provided; 4. All items or artifacts that I sell and/or exhibit being appropriate and consistent with the purpose of the event (event organizers have the right and authority to refuse and/or remove items or artifacts deemed inappropriate); 5. Successful completion of UC Davis Fire Department and UC Davis Office of Environmental Health and Safety (EH&S) inspections; and 6. Refraining from advertising or promoting this event (publicity is the sole right of UC Davis). I realize that failure to achieve satisfactory onsite Fire Department and/or EH&S inspections and/or failure to comply with the stated requirements are grounds for being excluded from participation in this and possibly future events on the UC Davis campus. I agree that fees already paid will not be refunded should my booth not satisfy the conditions stated in the Vendor Application and Information Attachments. I am also aware that if I have any questions regarding the requirements, I can contact EH&S at (530 ) and the Fire Department at (530) for assistance. Signature: Date: 7 RETURN COMPLETED APPLICATIONS TO EVENT SPONSOR LISTED ON PAGE 1 For Office Use Only Accepted by: (UC Davis Environmental Health & Safety) Accepted by: (UC Davis Fire Department) Accepted by: (Event Sponsor) Date: Date: Date: