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MOBILE FOOD VENDOR APPLICATION

City of Manchester | 208 E Main Street, Manchester, IA 52057

Office: 563-927-3355

COMPLETED APPLICATION MUST BY SUBMITTED AT LEAST 5 DAYS PRIOR TO THE FIRST DATE OF SALES

FEE:

 Annual  $150

 6-Months  $100

 Per Week  $25

 Per Day  $10

Date of Application: 

BUSINESS INFORMATION

Business Name: 

Address:  City:  State:  Zip: 

Phone:  Email: 

IA Sales Tax Permit No:  IA Food Establishment License No: 

Cuisine Sold: 

APPLICANT INFORMATION

 Owner      Employee

Applicant Name: 

Address:  City:  State:  Zip: 

Phone:  Email: 

Driver's License #/State:  DOB:  SS#: 

Hair/Eye Color:  Height/Weight: 

EMPLOYEE/VOLUNTEER INFORMATION

Name:  DOB:  Driver's License #: 

Name:  DOB:  Driver's License #: 

Name:  DOB:  Driver's License #: 

Have you, your employee, or your volunteer:

 Yes   No  Been convicted of a misdemeanor level crime, excluding traffic law violations.

 Yes   No  Been charged with a felony level crime regardless of convictions status. 

 Yes   No  Been convicted of, pled guilty to, or stipulated to the facts of a felony level crime.

 Yes   No  Been convicted of, pled guilty to, or stipulated to the facts of a forcible felony, including any felony child endangerment, assault, murder, sexual abuse, kidnapping, robbery, arson in the first degree, burglary in the first degree, or sexually motivated crime. 

Name:  Date of Arrest:  Charge: 

Name:  Date of Arrest:  Charge: 

VEHICLE INFORMATION

Type of Food Vendor:  Cart   Stand   Truck   Trailer

License Plate # and State: 

VIN:  Make:  Model:  Year:  Color:

Please include a photograph of mobile food unit.

BUSINESS OPERATIONS

Location (s) you will be vending: 

Days of Operation & Time: 

(Hours 7:00am - 9:00pm)

Last 3 cities you conducted business: 

City:  Date: 

City:  Date: 

City:  Date: 

 Yes   No  IA Food Establishment License on display. 

 Yes   No  Certified Food Protection Manager on site.  

 Yes   No  Written procedures/plans as specified in the Iowa Food Code on site. 

 Yes   No  I have been denied a Vendor Permit in the past. Reason: 

I ACKNOWLEDGE:

  Any falsification made herein before will constitute grounds for revocation of this license. 

  All applicable State of Iowa requirements have been met according to the Iowa Department of Inspections and Appeals. 

  I have complied with all applicable Federal and State laws and City ordinances, including reporting of sales tax. 

  Hours of operation shall be in forced from the hours of 7:00am - 9:00pm only.

  City permit shall be exhibited as evidence of compliance with all requirements of City code of Ordinance Chapter 122. 

  Mobile Vendor Permit issues is not transferable in any situation and is applicable only to the person filing the application. 

  The Police Department will conduct a background check on the applicant/employees/volunteers, including any criminal history records and driving records held by the State of Iowa and FBI as necessary. 

I am the proponent of the foregoing information, and the statement made and answers given above are true. I further swear I am of good moral character. 

Signature of Applicant/Title:  Date:

Police Chief:  Date: 

 Approved   Denied: 

 City Clerk Notified

 City Manager Notified