Mobile Food Unit License Application

Time Period of License/Fee Amount:

Check desired duration/fee:*

One Day License: $25

One Week License: $50

6 Month License: $100

1 Year License: $200

Date(s) that this license is requested for:*

Applicant/Employee Information

Owner/ Applicant Name:*

First Last

Business Name:*

Address*

Street Address City State / Province / Region ZIP / Postal Code

Phone/ Mobile Phone:*

Email*

Copy of Valid Driver's License

Max. file size: 2 MB.

Criminal History Background Check dated within the last 30 days:

If you do not have a Criminal History Background Check within the last 30 days, please download the request from the link you will find ABOVE on application page and upload to file or submit via email to cityhall@adeliowa.org.

Max. file size: 2 MB.

Mobile Food Unit Information:

Mobile Food Unit:*

Make:

Model:

Year:

Plate #

Food Unit Dimensions:*

Length

Width

Description and details of the mobile food unit (cooking facilities, preparation area, safety features):*

Photos of Food Unit (Front, Side, Back, Inside):*

Drop files here or

Max. file size: 2 MB.

Food Unit Vehicle Registration:

Max. file size: 2 MB.

Property Owner Consent to Operate Form:

Please download the Owner Consent from the link you will find ABOVE on application page and upload to file or submit via email to cityhall@adeliowa.org.

Max. file size: 2 MB.

Certificate of General Liability Insurance

Insurance in the amount of $1 million or more per occurrence and $1 million for property damage

Max. file size: 2 MB.

State of IA License Information:

State of IA License: IDIA Inspection Certificate #:*

Copy of State of IA License Certificate:

Max. file size: 2 MB.

Classification Level:*

Class I- Non-refrigerated vending units that serve only intact, non-potentially hazardous commercially prepackaged food and beverage

Class II- Refrigerated or hot vending units that serve potentially and non-potentially hazardous commercially prepackaged foods from an approved source. No cooking is allowed as part of a Class II unit.

Class III- Units that serve potentially and non-potentially hazardous packaged food and unpackaged foods with limited assembly. These units are limited to pre-cooked foods from an approved source that may be reheated on the unit.

Class IV- Units that serve potentially and non-potentially hazardous foods that are prepared, cooked, cooled, or reheated and assembled on the unit.

Consent Fields:

Consent:*

I understand I must carry the license with me and exhibit a copy of my license with each prospective customer upon their request.

have read and understand Chapter 122 of the Adel City Code.

I understand the provisions for suspension, revocation or denial of a license.

Indemnification:

To the fullest extent permitted by law, the applicant agrees to defend, pay on behalf of. Indemnify, and hold harmless the City against any and all claims, demands, suits, damages or losses, together with any and all outlay and expense connected therewith, including but not limited to attorneys’ fees and court costs, that may be asserted or claimed against, recovered from or suffered by the City by reason of any injury of loss, including, but not limited to, personal injury, including bodily injury or death, property damage, including loss of the use thereof, and economic damages arising out of or in any way connected or associated with the applicants activities.

Certification:

I certify that all information in this application and the required documents is true and correct to the best of my knowledge, and upon submittal becomes public record. I understand that any missing documentation may delay license approval. I further understand that should I commit a violation of the terms and conditions of this license; my license may be revoked. I agree that I will obtain any other permits necessary. The Undersigned, in support of their request for the issuance of a mobile food unit license, states the above statements are true and correct. It is understood that the activities related to mobile food vending shall comply with all applicable City Ordinances, including but not limited to Adel Code of Ordinances, Chapter 122: Peddlers, Solicitors, Transient Merchants and Mobile Food Units.

Applicant Signature:*

I/We acknowledge that by submitting this form, my/our electronic signature(s) carries the same weight as my(our) print signature(s) and is therefore legally binding.

Date

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Mobile Food Unit License Application

Mobile Food Unit Fees:

One Day License $25
One Week License $50
6 Month License $100
1 Year License $200

Application Checklist: