{[PNAME]}
{[ADDR]}
{[CITY]}, {[STATE]} {[ZIP]}
{[APHONE]}
{[AWEBSITE]}
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REQUIREMENTS FOR SPECIAL EVENT AND MOBILE FOOD VENDOR APPLICATIONS
ALL DOCUMENTS MUST BE SUBMITTED 14 DAYS PRIOR TO EVENT

Required Documents

  1. A copy of a valid Food Manager or Food Handler Certificate for the Person In Charge at the event
  2. A copy of a valid Retail Food Establishment License for your Mobile Establishment and/ or Commissary.
  3. A copy of your Commissary Agreement (if you operate out of a commercial kitchen / food establishment)
  4. A copy of your most recent Risk-Based Sanitary Inspection Report or your current Evaluation Placard issued by the Health Department that issued your Food Establishment / Commissary license.
  5. $35 Fee (cash or check to the Borough of Bergenfield)
  6. A copy of your current Certificate of Insurance ($500,000 min)

If your mobile vendor has gas appliances, a fire permit is also required.

  1. The fire permit must be filled out on an original form. The form can be mailed to you or picked up in person. Please contact the Fire Department 201-387-4055 ext 4074 with questions.
  2. You must have a fire extinguisher on site and readily available.
  3. You must have Proof that the hood system has been cleaned.
  4. $54 Fee (cash or check made out of the ‘Borough of Bergenfield.’)

Cottage Food Operators

  1. A valid cottage food operator permit issued by the New Jersey Department of Health.
  2. A copy of your label
  3. A layout of your table set up

Failure to submit permit applications within the time frame allowed may result in a denial of the vendors application and/or a late fee of $5.00 from the Health Department. All inspections will be conducted on the day of the event and your permit to operate will be provided at that time. Please arrive on time to allow for inspection prior to operation.

Please contact the Health Department at 201-387-4055 ext 5 if you have any questions regarding the Application process.

Business Owner Information
Applicant Information
State
Email
State
City
Business Owner Same as Applicant?
Expiration Date
City
Email
Name
ZIP
Contact Person Information
President/Manager (if applicable)
License Number
Email
Phone #
ZIP
Address
Phone #
Address
Phone #
Name
Name
Contact Person Same as Applicant?
Name of Mobile Food Vendor
The Event Coordinator is responsible for ensuring this application, additional attached documentation and fees of theparticipating food vendor is submitted at least 2 weeks prior to the date of the event. All vendors are required to ensure operational compliance and are held to the most recent New Jersey Chapter 24 of Sanitation in Retail Food Establishments and Food and Beverage Vending Machines standards. The Bergenfield Health Department reserves the right to refuse a mobile food vendor’s participation, if they fail to submit all required paperwork with this application, do not at least meet the minimal food safety regulations or a permit is not issued prior to the date of the event being held.
How will food be kept at proper hot/cold temperatures during transportation, while on display, and while on site for storage?
Location of Event (Street, City, State, Zip)
Event Coordinator Phone #
Names and expiration date of all the food handler/managers that will be on site during the event? (NJ State Approved Food Manager/ Handler Certifications only):
Event Type
License Plate #
Food Safety Questions
Event Coordinator Email
What food will be Served?
Type of Mobile Vendor
Event Type
Date and Time Event End
Event Name
Name and Best Contact information for Vendor: (Main/Cell Phone #, E-Mail Address, Fax # etc.)
Address of Commissary (Street, City, State, Zip Code)
Where will the food be Prepared?
Mobile Food Vendor Information
Name of Commissary/Retail Establishment
If food preparation is off site please give location(s):
Where will food be purchased?
Event Coordinator Name
If Other, please specify the event
How will you eliminate bare hand contact with ready-to-eat food?
Temporary Food Event Information
Date and Time Event Start
Type Full Name :
Sign With Hand
Certification
Does your business currently have a food license issued by any Municipality, County or State Health Department?
Please attach menu of food to be sold:
Have you reviewed, and understood the form: Requirements for Temporary Food Events?
{[PNAME]} are assessed at the fixed rate of $35.00 per license.
License Fee
Applicant Signature
Fee
The undersigned do hereby apply for a license to operate a food business in the {[CNAME]}. I/We agree to abide by the regulations and ordinances of the Township and the State of New Jersey.
Attachments
If so, from where?