The Florida Commissary Letter Of Agreement form is a crucial document provided by the Florida Department of Agriculture and Consumer Services, specifically for mobile food establishments or package ice plant self-vending permit applications requiring a commissary. It confirms the agreement between the mobile food vendor or self-vending ice unit and their primary commissary, ensuring the vendor's compliance with the necessary health and safety standards. Before moving forward with your permit application, make sure to accurately fill out and submit this form to the appropriate FDACS inspector. Click the button below to start filling out your form.
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The Florida Commissary Letter of Agreement form is a critical document for individuals operating mobile food establishments or self-vending ice units within the state. Managed by the Florida Department of Agriculture and Consumer Services' Division of Food Safety, this form acts as a bridge, ensuring that such businesses meet specific health and operational standards by affiliating themselves with an approved commissary. The form gathers detailed information on the mobile food establishment or self-vending ice unit, including ownership details and the scope of operations. It requires the owner to certify the accuracy of provided details and acknowledge the condition that permit approval hinges on the verification of the affiliated commissary's credentials. The form further delves into the specifics of the primary commissary, capturing vital details like the commissary's name, address, license number, and the types of services it will provide to the mobile unit, ranging from food storage to waste disposal. By signing the agreement, both the mobile unit and commissary grant food inspectors permission to evaluate the facilities, ensuring compliance with health standards. This form is indispensable for operators seeking to navigate the regulatory landscape of mobile food vending or ice vending, as it outlines the partnership and operational expectations between the mobile unit and the commissary, streamlining the permit application process.
| Question | Answer |
|---|---|
| Form Name | Florida Commissary Letter Of Agreement Form |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | commissary lease contract, commisary letter of agreement florida, dept of ag fillable pdf for commissary, commissary agreement letter florida |
Florida Department of Agriculture and Consumer Services
Division of Food Safety
COMMISSARY LETTER OF AGREEMENT
Bureau of Food and Meat Inspection 3125 Conner Boulevard Tallahassee, FL (850)
This form is to be filled out and given to the FDACS inspector in the field and submitted as part of a mobile food establishment permit application or with a package ice plant permit application that requires a commissary.
SECTION 1– MOBILE FOOD ESTABLISHMENT (MFE) OR SELF VENDING ICE UNIT (SVIU) INFORMATION
Phone Number (include area code)
Owner Mailing Address
Zip Code (+4 optional)
I hereby certify the provided information is correct and understand permit approval is contingent upon verification of an approved commissary.
Print Name (Owner of MFE or SVIU)
Signature ( Owner of MFE or SVIU)
SECTION 2 – PRIMARY COMMISSARY INFORMATION
Primary Commissary Name
Zip Code (+4 optional)
Primary Phone Number (include area code)
Commissary License/Permit Number
Department of Agriculture & Consumer
Department of Business and
Department of Health
Water Supply of Primary
Wastewater Disposal of
Septic Tank System
I intend to provide the following activities at this commissary:
Dish or equipment washing
Storing of food and dry goods (room temperature)
Cold Storage of food (including ice and drinks)
Receiving potable water
Cooking and/or reheating food
Washing the outside of the vehicle
Three compartment sink
Other (Describe below)
Describe other activities here:
Signing this document will allow FDACS Food Inspectors entry to my business during normal hours of operation for evaluation of facilities.
Print Name (of Person in Charge of Commissary)
Signature (of Person in Charge of Commissary)
Are additional commissaries used?
If yes use as many pages as needed.
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Concentrate when filling in this pdf. Ensure that every single field is filled in accurately.
1. Complete the letter of online agreement with a group of major fields. Collect all of the necessary information and ensure absolutely nothing is forgotten!
2. The subsequent part would be to fill in the following fields: Licensed By check one, Department of Agriculture Consumer, Department of Business and, Services, Professional Regulation, Department of Health, None, Water Supply of Primary Commissary, MunicipalUtility, Supplier Name, Onsite Well, Permit Number, MunicipalUtility, Supplier Name, and Wastewater Disposal of Primary.
Always be extremely mindful when filling out Licensed By check one and Supplier Name, since this is the part in which most users make mistakes.
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