Form Center • Edina, MN • CivicEngage

Seasonal Temporary Food Stand License Application

Steps

1. Application Details This section is complete This section is incomplete
2. Insurance This section is complete This section is incomplete
3. Food Safety Tips This section is complete This section is incomplete
4. Submission This section is complete This section is incomplete

Application Details

A seasonal temporary food stand is a food and beverage service establishment that is a food stand which is disassembled and moved from location to location, but which operates for no more than 21 days annually at any one location.
Business/Organization Name*
Location of Operation*
Dates of Operation*
Contact Person*
Phone Number*
Address*
City*
State
Zip Code
Email Address*
Application Fee
Application Fee
Price
Quantity
Shipping Cost
Taxable
Provide your Minnesota Tax ID Number. If a Minnesota Tax ID Number is not required, explain why.*
Provide a Federal Tax ID or Social Security Number.*
List all other food licenses or permits currently held by this operation at the time of application. If any of these licenses or permits have been suspended or revoked, provide an explanation. *
List ALL food and beverage items to be served*
Where will food be obtained? *
How will food be prepared, chilled, and stored prior to the event?*
Mechanical refrigeration is required for potentially hazardous foods; ice filled coolers are not permitted for food storage. Home kitchens may not be used.
What is the method of transporting food, including type of vehicle and types of electric or insulated food transport containers?*
List equipment to be used to maintain food above 135° F and below 41° F.*
Mechanical refrigeration is required for cold storage of potentially hazardous foods; coolers and ice are not permitted.
Where will food be kept during the event? *
Food must be kept a minimum of 6 inches off the floor and protected from contamination.
Describe facilities for washing hands.*
Include soap and single-use towels at the hand-washing station/sink.
Note: A handwash station/sink capable of providing warm, continuously running water, is required.
Describe facility for washing utensils.*
All utensils must fit into the sinks or containers used for warewashing.
Identify water source for the food stand or vehicle.*
Describe method of waste water disposal.*
Describe type of protective enclosure, if any (tent, trailer, etc). Approved flooring must be provided (concrete, asphalt, tight wood, or other cleanable material. *
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Insurance

Insurance Company Name
Please do not provide the name of the insurance agent.
Policy Number
Expiration Date
I am not required to have workers' compensation liability coverage because:
1. I have no employees.
2. I am self-insured (include permit to self-insure below).
3. I have no employees who are covered by the workers' compensation law (these include: Spouse, Parents, Children, and certain farm employees).
Upload a certificate of insurance or permit to self-insure.
I certify that I have provided proof of coverage or I am not required to have workers' compensation liability coverage.*
1. I agree.
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Food Safety Tips

Food Safety Tips for Food Stands
Provide a metal stem thermometer to measure cooking and cold holding temperatures. The thermometer should have a range from 0°F to 220°F. Also, provide thermometers in each cooling unit to ensure they are maintained at 41°F or below. Cook all potentially hazardous foods to an internal temperature of 165°F before serving. Any food held hot for service must be maintained at 135°F or higher. Wash hands before handling food; after handling raw meat; or after eating, drinking, smoking, or using the toilet. No eating, drinking, or smoking in the food stand. Protect any food on display from contamination by customers. Temporary food stands must cease operation in adverse weather unless the stand is equipped with a cover and three sides for protection. Call 952-826-0370 with any questions regarding temporary events in the City of Edina.
Certification of Compliance Minnesota Workers' Compensation Law
Minnesota Statute, Section 176.182 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 an activity in Minnesota until the applicant presents acceptable evidence of compliance with the workers' compensation insurance coverage requirement of Chapter 176. The information required is: the name of the insurance company, the policy number and dates of coverage or the permit to self-insure. This information will be collected by the licensing agency and retained in their files. This information is required by law, and licenses and permits to operate a business may not be issued or renewed if it is not provided and/or is falsely reported. Furthermore, if this information is not provided or falsely stated, it may result in a $2,000.00 penalty assessed against the applicant by the Commissioner of the Department of Labor and Industry.
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Submission

THE MINNESOTA DATA PRACTICES ACT requires that we inform you of your rights about the private data we are requesting on this form. Private data is available to you, but not to the public. We are requesting this data to determine your eligibility for an addendum to your license from the City of Edina. Providing the data may disclose information that could cause your application to be denied. You are not legally required to provide the data, however, refusing to supply the data may cause your license to not be processed. Under MS 270.72, the City of Edina is required to provide the Minnesota Department of Revenue your MN Tax ID Number or Social Security Number. This information may be used to deny the issuance, renewal or transfer of your license if you owe the Minnesota Department of Revenue delinquent taxes, penalties, or interest. The Department of Revenue may supply information to the Internal Revenue Service. In addition, this data can be shared by Edina City Staff, the State of Minnesota Driver License Section, Hennepin County Auditor, Bureau of Criminal Apprehension, Hennepin County Warrant Office, Ramsey County Warrant Office, the Minnesota State Auditor and if required by a court order. Applicant’s residence address and telephone number will be considered public data unless you request this information to be private and provide an alternative address and telephone number. Applicant’s signature on this application indicates applicant has read and understands their right regarding Data Practices*
1. I agree.
By checking the box below you certify all information given is complete and accurate and that you agree to the above Data Practices Act.*
1. I agree.
I request that my residence address and telephone number be considered private data. My alternative address and telephone number are as follows:
Address
Telephone Number

Leave This Blank:

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