Blank Florida Commissary Letter Of Agreement PDF Form

Blank Florida Commissary Letter Of Agreement PDF Form

The Florida Commissary Letter Of Agreement form is a document required by the Florida Department of Agriculture and Consumer Services for mobile food establishments and self-vending ice units. This form must be completed and submitted to an FDACS inspector as part of the permit application process, ensuring compliance with food safety regulations. To begin the process, fill out the form by clicking the button below.

The Florida Commissary Letter of Agreement form is an essential document for mobile food establishments and self-vending ice units seeking to operate legally within the state. This form must be completed and submitted to the Florida Department of Agriculture and Consumer Services (FDACS) as part of the permit application process. It serves to establish a formal relationship between the mobile food vendor and the primary commissary, which is a licensed facility that provides necessary support services. Key sections of the form require detailed information about the owner of the mobile food establishment, including their contact details and permit number, as well as specifics about the commissary itself, such as its address, license number, and the types of activities it supports, like food storage and equipment washing. By signing this agreement, the owner certifies the accuracy of the information provided and grants FDACS inspectors the right to evaluate the commissary facilities during regular business hours. The form also allows for the inclusion of additional commissaries if needed, ensuring that all operational aspects are covered. This comprehensive approach helps maintain food safety standards and ensures that mobile vendors can operate smoothly and legally.

Document Sample

Florida Department of Agriculture and Consumer Services

Division of Food Safety

COMMISSARY LETTER OF AGREEMENT

Bureau of Food and Meat Inspection 3125 Conner Boulevard C-26 Tallahassee, FL 32399-1620 (850) 245-5520

ADAM H. PUTNAM

COMMISSIONER

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 self-vending permit application that requires a commissary.

SECTION 1– MOBILE FOOD ESTABLISHMENT (MFE) OR SELF VENDING ICE UNIT (SVIU) INFORMATION

 

 

Owner Name

 

 

 

 

 

 

 

 

 

Phone Number (include area code)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Owner Mailing Address

 

 

 

 

 

 

 

Permit Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City

 

 

 

 

 

Zip Code (+4 optional)

 

County

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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)

 

 

 

Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SECTION 2 – PRIMARY COMMISSARY INFORMATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Primary Commissary Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Commissary Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City

 

 

 

 

 

Zip Code (+4 optional)

 

County

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Primary Phone Number (include area code)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Commissary License/Permit Number

 

 

Primary E-Mail Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Licensed By

 

Department of Agriculture & Consumer

 

Department of Business and

 

Department of Health

 

None

 

 

(check one)

 

Services

 

 

 

Professional Regulation

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Water Supply of Primary

 

Municipal/Utility

 

Supplier Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Commissary

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

On-site Well

 

 

Permit Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Municipal/Utility

 

Supplier Name

 

 

 

 

 

 

 

Wastewater Disposal of

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Septic Tank System

 

Permit Number

 

 

 

 

 

 

 

Primary Commissary

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Package Plant

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I intend to provide the following activities at this commissary:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Dish or equipment washing

 

Yes

No

 

 

Storing of food and dry goods (room temperature)

Yes

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Dumping wastewater

 

 

 

Yes

No

 

 

Cold Storage of food (including ice and drinks)

Yes

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Receiving potable water

 

Yes

No

 

 

Cooking and/or reheating food

 

 

Yes

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Washing the outside of the vehicle

 

Yes

No

 

 

Three compartment sink

 

 

Yes

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Restroom facilities

 

 

 

Yes

No

 

 

Other (Describe below)

 

 

Yes

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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)

 

Date

 

 

 

 

 

 

 

 

 

 

 

Are additional commissaries used?

Yes

No

If yes use as many pages as needed.

 

 

 

 

 

FDACS-14223 Rev. 10/15

 

 

 

 

 

 

 

 

 

 

 

 

Page 1 of 1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

File Specifics

Fact Name Details
Purpose The Florida Commissary Letter of Agreement form is required for mobile food establishments and self-vending ice units to secure a commissary for operations.
Submission Requirement This form must be filled out and submitted to the Florida Department of Agriculture and Consumer Services (FDACS) as part of the permit application process.
Governing Law The form is governed by regulations set forth by the Florida Department of Agriculture and Consumer Services under Chapter 500 of the Florida Statutes.
Inspection Authorization By signing the form, the owner grants FDACS food inspectors permission to enter the commissary for evaluation during normal business hours.

How to Use Florida Commissary Letter Of Agreement

Completing the Florida Commissary Letter Of Agreement form is essential for mobile food establishments or self-vending ice units. After filling out this form, you will need to submit it to the Florida Department of Agriculture and Consumer Services (FDACS) inspector as part of your permit application process. Here’s how to fill out the form step by step.

  1. Gather Required Information: Before starting, collect all necessary details, including your personal information, commissary information, and any additional activities you plan to conduct.
  2. Section 1 - Mobile Food Establishment (MFE) or Self Vending Ice Unit (SVIU) Information:
    • Enter the owner’s name.
    • Provide a phone number, including the area code.
    • Fill in the owner’s mailing address, including city and zip code.
    • Input the permit number.
    • Specify the county.
    • Certify that the information is correct by printing the owner's name, signing, and dating the form.
  3. Section 2 - Primary Commissary Information:
    • Enter the primary commissary name.
    • Fill in the commissary address, including city and zip code.
    • Provide the primary phone number, including the area code.
    • Input the commissary license/permit number.
    • Enter the primary email address.
    • Indicate which department licensed the commissary by checking the appropriate box.
    • Provide the name of the primary municipal/utility supplier.
    • Fill in the on-site well permit number, if applicable.
    • Provide the name of the municipal/utility supplier for wastewater disposal.
    • Fill in the septic tank system permit number, if applicable.
  4. Activities at the Commissary:
    • Indicate whether you will provide dish or equipment washing by checking Yes or No.
    • Repeat this for each activity listed, including storing food, dumping wastewater, cold storage, receiving potable water, cooking/reheating food, washing the vehicle, using a three-compartment sink, restroom facilities, and any other activities.
    • If you check "Other," describe the additional activities in the space provided.
  5. Final Signatures:
    • Print the name of the person in charge of the commissary.
    • Have the person in charge sign and date the form.
    • Indicate if additional commissaries are used by checking Yes or No. If yes, use additional pages as needed.

Your Questions, Answered

What is the purpose of the Florida Commissary Letter of Agreement form?

The Florida Commissary Letter of Agreement form is essential for mobile food establishments and self-vending ice units. This document must be completed and submitted to the Florida Department of Agriculture and Consumer Services (FDACS) as part of the permit application process. It ensures that the mobile food business has access to an approved commissary for necessary operations, such as food storage and washing equipment.

Who needs to fill out this form?

Both owners of mobile food establishments (MFE) and self-vending ice units (SVIU) are required to complete this form. It is crucial for anyone applying for a mobile food establishment permit or a package ice plant self-vending permit that necessitates a commissary. The owner must provide accurate information about themselves and the commissary they will be using.

What information is required on the form?

The form requires several key pieces of information, including:

  • Owner's name and contact information
  • Owner's mailing address and permit number
  • Primary commissary's name, address, and contact details
  • Commissary license or permit number
  • Details about the activities that will be conducted at the commissary, such as food storage and washing

Completing all sections accurately is vital for the approval of the permit.

What activities can be performed at the commissary?

Various activities can be conducted at the commissary, which are essential for the operation of mobile food establishments. These activities include:

  • Dish or equipment washing
  • Storing food and dry goods
  • Dumping wastewater
  • Cold storage of food
  • Receiving potable water
  • Cooking or reheating food
  • Washing the outside of the vehicle
  • Providing restroom facilities

It is important to indicate which of these activities will be performed by checking the appropriate boxes on the form.

What happens after the form is submitted?

Once the form is submitted, FDACS inspectors will review the information provided. They may conduct an evaluation of the commissary during normal business hours to ensure compliance with health and safety regulations. If everything is in order, the mobile food establishment or self-vending ice unit can proceed with the permitting process.

Are additional commissaries allowed, and how should they be documented?

Yes, if multiple commissaries are used, the form allows for additional documentation. Owners should indicate that more than one commissary is involved by checking the appropriate box and using additional pages as needed. Each commissary must be listed with its corresponding information to ensure proper verification and compliance.

Common mistakes

  1. Missing Information: One common mistake is leaving sections blank. Ensure that every field is filled out completely. This includes the owner’s name, phone number, and the commissary’s address.

  2. Incorrect Contact Information: Providing an incorrect phone number or email can lead to delays. Double-check that all contact information is accurate and up-to-date.

  3. Not Signing the Form: Forgetting to sign the document is a frequent oversight. Both the owner of the mobile food establishment and the person in charge of the commissary must provide their signatures.

  4. Inaccurate Permit Numbers: Entering the wrong permit number can cause issues during the application review. Verify that the permit number is correct before submitting the form.

  5. Ignoring Additional Commissaries: If you use more than one commissary, it’s important to indicate this on the form. Failing to disclose additional locations may result in complications with your application.

  6. Inadequate Description of Activities: When specifying activities at the commissary, be thorough. A vague description can lead to misunderstandings about what services will be provided.

Documents used along the form

The Florida Commissary Letter of Agreement form is essential for mobile food establishments and self-vending ice units. It helps ensure that these operations comply with health and safety regulations. Alongside this form, several other documents may be needed to complete the application process. Here’s a list of some commonly used forms and documents.

  • Mobile Food Establishment Permit Application: This document is required to obtain permission to operate a mobile food business in Florida. It includes details about the owner, vehicle, and proposed menu.
  • Self-Vending Ice Plant Permit Application: This form is necessary for businesses that wish to sell packaged ice. It outlines the operational standards and safety measures that need to be followed.
  • Food Safety Plan: A detailed plan that outlines how a food business will ensure safety and sanitation. This document is often required to show compliance with health regulations.
  • Health Inspection Report: This report provides the results of health inspections conducted by local authorities. It is crucial for demonstrating compliance with health standards.
  • Commissary License: This document proves that the commissary meets state requirements and is licensed to operate. It is essential for any mobile food business relying on a commissary.
  • Wastewater Disposal Permit: If a business uses a septic system, this permit is necessary to ensure proper wastewater management and compliance with local regulations.
  • Food Handler's Certificate: This certificate shows that employees have completed training in food safety practices. It is often required for all staff working in food service.
  • Proof of Liability Insurance: This document provides evidence of insurance coverage for the business. It protects against potential claims related to food safety or accidents.
  • Menu Submission: A list of food items that will be offered. This helps health inspectors assess whether the proposed menu meets safety standards.
  • Equipment Specifications: Details about the equipment used in the mobile unit or commissary. This includes information on cooking appliances, refrigeration units, and sanitation facilities.

Each of these documents plays a vital role in ensuring that mobile food operations comply with Florida’s health and safety regulations. Having them prepared and submitted correctly can streamline the application process and help avoid delays.

Similar forms

The Florida Food Establishment Permit Application is similar to the Florida Commissary Letter of Agreement form as both documents are essential for food service operations. This application is required for businesses that prepare or sell food to the public. It collects information about the food establishment, including its location, ownership, and the types of food served. Like the Commissary Letter, it ensures compliance with health and safety regulations, helping to maintain food safety standards within the state.

The Mobile Food Vendor License Application also bears similarities to the Florida Commissary Letter of Agreement form. This document is specifically for mobile food vendors, requiring details about the vendor's operation and the commissary used for food preparation and storage. Both forms necessitate verification of the commissary's approval, ensuring that mobile vendors have access to proper facilities for food safety and sanitation.

The Food Service Establishment Inspection Report is another document that aligns with the Florida Commissary Letter of Agreement. This report is generated during inspections of food establishments, including commissaries. It assesses compliance with health codes and safety regulations. Both documents emphasize the importance of maintaining sanitary conditions and proper food handling practices, serving as tools for regulatory oversight.

The Food Handler Training Certificate is related to the Florida Commissary Letter of Agreement as it emphasizes the need for food safety knowledge among staff. This certificate is awarded to individuals who complete training on safe food handling practices. While the Commissary Letter focuses on the facilities used, the Food Handler Training Certificate ensures that those working within those facilities are educated on proper food safety protocols.

The Health Department Permit is similar to the Florida Commissary Letter of Agreement because both documents are necessary for operating food-related businesses. The Health Department Permit certifies that a food establishment meets health and safety standards. Like the Commissary Letter, it requires submission of information about the business and its compliance with local regulations, ensuring a safe environment for food preparation and service.

The Ice Plant Permit Application parallels the Florida Commissary Letter of Agreement as both are used in the context of food and beverage operations. This application is specifically for businesses that produce or sell ice. It requires information about the facility and its compliance with health standards. Both documents aim to ensure that all food-related businesses adhere to safety regulations, protecting public health.

Finally, the Temporary Food Event Permit Application is akin to the Florida Commissary Letter of Agreement. This application is required for vendors participating in temporary events, such as fairs or festivals. It collects information about the vendor and their food sources, including the commissary. Both documents ensure that food served at temporary events meets health and safety standards, thereby safeguarding consumers during these occasions.

Dos and Don'ts

When filling out the Florida Commissary Letter Of Agreement form, it's important to ensure accuracy and compliance. Here are some key dos and don’ts to keep in mind:

  • Do provide accurate and complete information for all required fields.
  • Do double-check the contact information for the primary commissary.
  • Do ensure that the owner’s signature is included before submission.
  • Do specify all activities that will take place at the commissary.
  • Don't leave any sections blank; incomplete forms may delay processing.
  • Don't forget to keep a copy of the completed form for your records.

Misconceptions

Misconceptions about the Florida Commissary Letter Of Agreement form can lead to confusion and delays in the permitting process. Here are seven common misunderstandings:

  1. This form is only for mobile food vendors. Many believe that the Commissary Letter Of Agreement is exclusive to mobile food establishments. However, it is also applicable to self-vending ice units that require a commissary.
  2. Only one commissary can be listed. Some think they can only use a single commissary. In reality, if multiple commissaries are utilized, the form allows for additional pages to be submitted.
  3. The form is optional. There is a misconception that this form is not necessary for permit applications. In fact, it is a required document for both mobile food establishment and package ice plant self-vending permit applications.
  4. All sections must be completed in detail. While it is important to provide accurate information, some sections may not apply to every situation. For instance, if certain activities do not occur at the commissary, they can be marked as “No.”
  5. Signing the form gives up business privacy. Some individuals worry that signing the form allows inspectors unrestricted access. The form only permits entry during normal business hours for the purpose of evaluation.
  6. The commissary must be located within the same county. Many assume that the commissary must be in the same county as the mobile food establishment. There are no such restrictions, as long as the commissary meets all regulatory requirements.
  7. Once submitted, the information cannot be changed. It is a common belief that the information on the form is set in stone. However, if there are changes in ownership or commissary details, updates can be made by submitting a revised form.

Understanding these misconceptions can help streamline the application process and ensure compliance with Florida's food safety regulations.

Key takeaways

Key Takeaways for Filling Out the Florida Commissary Letter Of Agreement Form

  1. The form must be completed and submitted to the FDACS inspector during the mobile food establishment permit application process.
  2. Accurate information is essential. Ensure all details, including names, addresses, and permit numbers, are correct before submission.
  3. Certification by the owner of the mobile food establishment or self-vending ice unit is required. This includes a signature and date.
  4. Provide comprehensive information about the primary commissary, including its address, phone number, and license/permit number.
  5. Indicate the specific activities that will take place at the commissary. This includes dishwashing, food storage, and wastewater dumping.
  6. Signing the document grants FDACS Food Inspectors the right to enter the commissary during normal operating hours for evaluation.