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SPECIAL PARK MOBILE FOOD DISPENSING PERMIT APPLICATION

  1. SECTION 1: VENDOR INFORMATION

  2. SECTION 2: LOCATION INFORMATION

  3. Services Requested

  4. Space Requested

  5. SECTION 3: REQUIRED DOCUMENTATION

    Upon submission of this application the following documentation will be required before a final permit will be issued and may be requested by a member of the Special Events Division upon submission of this application.

  6. Application Fee

    Such application shall be accompanied by a non-refundable application fee. The fee shall be in the form of cashier’s check or money order made payable to the City of Hollywood. A credit card authorization may also be accepted.

  7. Certificate of Insurance

    The City of Hollywood (City of Hollywood 2600 Hollywood Boulevard Hollywood, FL 33020) must be listed as certificate holder and additionally insured on both the General Liability ($1,000,000) and Automobile Liability ($100,000) policies.

  8. City of Hollywood Fire Marshal Inspection

    Must be obtained by the City of Hollywood Fire Department. Contact 954.967.4404 to schedule an annual inspection.

  9. City of Hollywood Business Tax Receipt

    Must be obtained by the City of Hollywood Treasury Services Division located at Hollywood City Hall, 2600 Hollywood Boulevard, Room 103 (first floor). Contact 954.921.3225 for more information.

  10. Food Handler's Certificate

    SafeServ Food Service Certificate (National Restaurant Association)

  11. Mobile Food Dispensing License

    Issued by the State of Florida Department of Business and Professional Regulation or Department of Agriculture.

  12. Indemnification Agreement

    To be executed by authorized agent of the organization.

  13. Map of Location

    To be submitted by applicant

  14. Menu

    To be submitted by applicant

  15. SECTION 4: APPLICATION SUBMISSION*

    The information I have provided in this application is true and complete to the best of my knowledge. I have read and understand the accompanying materials.

  16. Leave This Blank:

  17. This field is not part of the form submission.