Environmental Health Department

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1 Environmental Health Department Enclosed is the 2018 Food Truck License application. Attached are the following documents that need to be returned prior to issuing your food license: Application for Food License Minnesota Business Tax Identification form Workers Compensation Insurance form The city will require an initial inspection of the food truck and will only require re-inspections if necessary. If a re-inspection is required, an additional fee will apply. Food trucks are allowed within the city if the property owner grants written permission to be on-site. A signed consent form must be kept in the food truck on the day of the event. If you will be operating a newly built truck, please read the attached Supplemental Information. Type of License 2018 Fee Class B Mobile food vendor, limited food vendor, mobile food car, or similar facility (see attached requirements including supplemental information and consent form) $250 Plan Reviews: New Establishment Fee: 100% of license fee Remodel Fee: 50% of license fee Hazard Analysis Critical Control Plan (HACCP) $150 Re-inspections: Second re-inspection Fee: 25% of license fee Third or more re-inspection Fee: 50% of license fee Please send your application and fee to: City of Minnetonka Community Development Licensing Minnetonka Blvd Minnetonka, MN Questions: Kathy Leervig, (952) or kleervig@eminnetonka.com

2 COMMUNITY DEVELOPMENT-LIC MINNETONKA BLVD MINNETONKA, MN (952) Fax (952) Please enter a response on every line. Any incorrect information or an incomplete application is a violation of the City Ordinance and can result in denial of licensing and/or prosecution. ESTABLISHMENT Establishment/trade name Establishment address City, State, Zip Application for Food Truck License for (insert year) Establishment phone number address Manager or agent of owner LICENSEE INFORMATION State Law: this must be a corporation or partnership name, or the individual s name that carries the tax liability. Licensee name Primary Officer Licensee address City, State, Zip Telephone Number Return license and send all notices & billing renewals to (all must be sent to the same address) Company Name Attention Address Telephone Number address CLASS & FEE INFORMATION (use only the same Class name and fee as on the Food Fee Schedule): Type of business: Class $ Additional business: Class $ Additional business: Class $ Additional business: Class $ Additional business: Class $ Total $ Note: Proper signature required: if a corporation owns this establishment, an officer of the corporation must sign below; if a partnership, one of the partners; if an individual, the owner. I, (WE) THE UNDERSIGNED, HAVE COMPLIED WITH ALL REQUIREMENTS OF THE CITY CODE OF THE CITY OF MINNETONKA NECESSARY FOR OBTAINING THIS LICENSE. NOW, THEREFORE, I (WE) HEREBY MAKE APPLICATION TO OPERATE THE ABOVE NAMED ESTABLISHMENT SUBJECT TO ALL CONDITIONS AND PROVISIONS OF THESE ORDINANCES. Print name: Signature Date Print title:

3 MINNESOTA BUSINESS TAX IDENTIFICATION LAW Pursuant to Minnesota Statute 270C.72 (Tax Clearance; Issuance of Licenses), Subd.4, the licensing authority is required to provide, upon request of the Minnesota Commissioner of Revenue, either the applicant s Minnesota business tax identification number with the business name and address or the social security number of the primary officer, along with their complete name, home address, and home phone number. Under the Minnesota Government Data Practices Act and the Federal Privacy Act of 1974, we are required to advise you of the following regarding the use of this information: 1. This information may be used to deny the issuance or renewal of your license in the event you owe Minnesota sales, employer's withholding, or motor vehicle excise taxes. 2. Upon receiving this information, the licensing authority will supply it only to the Minnesota Department of Revenue. However, under the Federal Exchange of Information Agreement, the Department of Revenue may supply this information to the Internal Revenue Service. 3. Failure to supply this information may jeopardize or delay the processing of your license issuance or renewal application. NAME UNDER WHICH THE MN TAX ID IS FILED (licensee name) Type of license applying for: Food Truck Licensee: Address L City L State L Zip L Phone Establishment: Name Minnetonka License Number (completed by Minnetonka) Establishment: Address E City E State E Zip E Phone Minnesota Tax Identification Number Federal Tax Identification Number Signature: Date: INSTRUCTIONS FOR BOXES BELOW: 1. If all boxes above are completed, including both the Minnesota and Federal Tax numbers, no additional information is required by the MN Department of Revenue below. 2. However, if all boxes above are not completed, Minnesota law requires personal information about the primary owner or primary officer. In this case you must complete all boxes below, including the owner or primary officer s social security number, home address, and home phone. (NOTE: If the business and home address are the same, please check the box indicating this.) Applicant s (person s) name (LAST, first, middle initial) Social Security Number Home address Check if address is for both home & business Home City, State, Zip code Home Phone number Signature: Date:

4 Certificate of Compliance Minnesota Workers Compensation Law Minnesota Statutes, Section requires every state and local licensing agency to withhold the issuance or renewal of a license or permit to operate a business or engage in any activity in Minnesota until the applicant presents acceptable evidence of compliance with the workers' compensation insurance coverage requirement of Minnesota Statutes, Chapter 176. The required workers compensation insurance information is the name of the insurance company, the policy number, and the dates of coverage, or the permit to self-insure. If the required information is not provided or is falsely stated, it shall result in a $2,000 penalty assessed against the applicant by the commissioner of the Department of Labor and Industry. A valid workers compensation policy must be kept in effect at all times by employers as required by law. BUSINESS NAME (Individual name only if no company name used) DBA (doing business as name local establishment name only if different than above) LICENSE OR PERMIT NO (if applicable) Completed by Minnetonka DBA/LOCAL BUSINESS ADDRESS (PO Box must include street address) CITY STATE ZIP CODE YOUR LICENSE OR CERTIFICATE WILL NOT BE ISSUED WITHOUT THE FOLLOWING INFORMATION. You must complete number 1, 2 or 3 below. NUMBER 1 COMPLETE THIS PORTION IF YOU ARE INSURED: INSURANCE COMPANY NAME (not the insurance agent) WORKERS COMPENSATION INSURANCE POLICY NO. EFFECTIVE DATE EXPIRATION DATE NUMBER 2 COMPLETE THIS PORTION IF YOU ARE SELF-INSURED: I have attached a copy of the permit to self-insure. NUMBER 3 COMPLETE THIS PORTION IF YOU ARE EXEMPT: I am not required to have workers compensation insurance coverage because: I have no employees. I have employees but they are not covered by the workers compensation law. (See Minn. Stat for a list of excluded employees.) Explain why your employees are not covered:. Other: ALL APPLICANTS COMPLETE THIS PORTION: I certify that the information provided on this form is accurate and complete. If I am signing on behalf of a business, I certify that I am authorized to sign on behalf of the business. APPLICANT SIGNATURE (mandatory) TITLE DATE NOTE: If your Workers Compensation policy is cancelled within the license or permit period, you must notify the agency who issued the license or permit by resubmitting this form. This material can be made available in different forms, such as large print, Braille or on a tape. To request, call (DIAL-DLI) Voice or TDD (651)

5 MOBILE FOOD VEHICLES/TRUCKS SUPPLEMENTAL INFORMATION The Food License application, Supplemental Information, and fee must be submitted and approved, prior to vehicle/truck inspection. The inspection ensures compliance with all Food Code requirements, prior to issuance of the Mobile Food Vehicle/Truck license. Application Requirements Provide a list of menu items to be served and/or sold including if the product is raw, precooked, prewashed, where it is prepared (on the truck or at the commissary), etc. Equipment list and cut sheets to support the menu preparation/food storage. Details on food source, preparation, and processes. Address of the affiliated commissary where the Mobile Food Vehicle/Truck will be cleaned and stored on a daily basis. If not in Minnetonka, a copy of the food license for the commissary must also be submitted. Copy of the current MDH Food Manager Certification. Copy of the standard operating procedures for cleaning and sanitizing the equipment and vehicle. Documented process of filling for fresh water. Documented process of dumping of the grey water. Plans & Specifications Floor plan drawn to scale of the Mobile Food Vehicle/Truck, which includes the location of all equipment. Finish schedule of floor, coving, walls and ceiling in Mobile Food Vehicle/Truck. Manufacturer s specification sheets for all equipment, with the NSF or equivalent approval. Water heater capacity. Fresh water capacity. Grey water capacity (grey water tank must be 15% larger than the fresh water tank). Environmental Health Inspection Please call (952) to schedule an inspection. In addition to the initial inspection, the Mobile Food Vehicle/Truck will receive routine inspections similar to the inspections conducted at all other food facilities within Minnetonka.

6 APPLICATION STANDARDS MOBILE FOOD VEHICLES/TRUCKS All mobile food vendors must operate in conformance with the following standards: Must obtain city of Minnetonka mobile food vendor license. The vendor license must be visible from the outside of the vehicle at all times. Must have underlying property owner s permission. The property owner and mobile food vendor must complete the mobile food vendor consent form. This form validates property owner permission and must be located within the vehicle at all times. Should the property owner be unavailable, the city will accept permission from the property manager. Must have a licensed stationary commissary or commercial kitchen. Must submit proof of licensed commissary or kitchen with the mobile food vendor license application. Hours of operation are from 7:00 a.m. until 10:00 p.m. Mobile food vendors and vehicles must depart from the property immediately following the closing of the operation. No bollards, seating, equipment not affixed to the vehicle is permitted. Signage is limited to signage affixed to the vehicle. No sound amplification, noisemakers or flashing lights is permitted. Must provide refuse containers for the customers. The operator of the mobile food vendor vehicle is responsible for removing all litter and garbage associated with the food truck. Failure to comply Failure to comply with the above listed standards will result in one of the following: Required relocation of the mobile food vendor. Required removal from the property. Revocation of the mobile food vendor license.

7 Mobile Food Vendor License Mobile food vehicle vendor: A self-contained truck or trailer used to prepare and serve food that is readily movable without disassembling. Limited mobile food vendor: A vehicle from which prepackaged items such as ice cream, pop and candy are sold. Mobile food cart: A non-motorized push cart that sells prepackaged or ready-to-eat foods on public sidewalks in downtown. Food vehicle: A vehicle used to deliver containers of food prepared by a licensed food establishment. Food is not prepared or sold from the vehicles directly to individual customers. Catering food vehicles are licensed with as an addition to a food establishment and do not require a mobile food vendor license. Mobile food vendor standards All mobile food vendors must operate in conformance with the following standards. Violating these standards may result in citations, fines, suspensions or revocation of your license to operate within the city of Minnetonka. 1. Must obtain city of Minnetonka mobile food vendor license. 2. Must have underlying property owner permission. This property owner must complete the attached consent form. This form validates property owner permission and must be located within the vehicle at all times. 3. Must have a licensed commissary or commercial kitchen. Must submit proof with the mobile food vendor license. 4. Hours of operation are from 7:00 a.m. until 10:00 p.m. Mobile food vendor vehicle must depart from the property immediately following the closing of operation. 5. No bollards, seating, external signage or equipment not affixed to the vehicle is permitted. 6. No sound amplifying equipment, televisions, lights or noisemakers.

8 7. Must provide refuse containers for the customers. The operator of the mobile food vendor vehicle is responsible for removing all litter and garbage associated with the food truck. 8. If the mobile food vendor vehicle is creating a safety, traffic, or pedestrian hazard the city reserves the right to require: (1) be moved to another location on the property; (2) be removed from the property; or (3) revoke the mobile food vendor license. Questions? If you have any questions regarding the information provided or required for the mobile food license, please contact

9 City of Minnetonka Minnetonka Boulevard Minnetonka, MN Phone: Fax: Letter of Consent This letter hereby authorizes, to park a mobile food vendor vehicle on my private property at. Per the license, the food truck operator may operate from 7 a.m. until 10 p.m. If agreed upon operating times are different than allowed by the license please include specific information in the space below. This consent shall run concurrent with the license unless otherwise noted below. At the time the license expires or is revoked, this consent is void. The owner and operator of the mobile food vendor are required to comply with all applicable sections of the Minnetonka City Code and the mobile food vendor license. Any remarks or conditions agreed upon not included above: Property Owner Name (please print) Signature Phone number Food Vendor is allowed on-site the following dates:, 2018 to, 2018 Vendor Name (please print) Signature Phone number Date

Mobile Food Vendor (Food Truck) Licensing

Mobile Food Vendor (Food Truck) Licensing Mobile Food Vehicles (Food Trucks) are motorized vehicles engaged in the business of cooking, preparing and distributing food or beverage in public and private