SPECIAL PARK MOBILE FOOD DISPENSING PERMIT APPLICATION

2. SECTION 1: VENDOR INFORMATION

4. Owner/Operator*

5. Business Name*

7. d.b.a.

9. Address1*

11. Address2

13. City

14. State

15. Zip

17. Contact Number*

18. Contact Email*

22. SECTION 2: LOCATION INFORMATION

24. Location Type*
    -- Select One --City of Hollywood ParkSpecial Event

25. Name of Park

26. Name of Event

28. Term Requested*
    -- Select One --6 Month Permit ($85.60)12 Month Permit ($144.45)

29. Services Requested

    1. Water
    2. Electric

30. Space Requested

    1. Tables (3 Maximum)
    2. Chairs (4 maximum per table)

34. 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.

    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.

36. 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.

    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.

37. 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.

    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.

39. 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.

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

40. 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.

    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.

42. Food Handler's Certificate
    SafeServ Food Service Certificate (National Restaurant Association)

    SafeServ Food Service Certificate (National Restaurant Association)

43. Mobile Food Dispensing License
    Issued by the State of Florida Department of Business and Professional Regulation or Department of Agriculture.

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

45. Indemnification Agreement
    To be executed by authorized agent of the organization.

    To be executed by authorized agent of the organization.

46. Map of Location
    To be submitted by applicant

    To be submitted by applicant

47. Menu
    To be submitted by applicant

    To be submitted by applicant

51. 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.

    1. Agreed
Leave This Blank:


53. 1. Receive an email copy of this form.
54. Email address

    This field is not part of the form submission.

55. Submit

* indicates a required field