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Florida Commissary Letter Of Agreement Form in PDF

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 package ice plants. This form must be completed and submitted to an FDACS inspector during the permit application process. It ensures that the mobile food business has access to an approved commissary for necessary operations.

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Florida Commissary Letter Of Agreement Form in PDF

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The Florida Commissary Letter of Agreement form plays a crucial role in the regulatory framework governing mobile food establishments and self-vending ice units in Florida. 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 is essential for ensuring that mobile food vendors have access to a licensed commissary, which is a facility that provides necessary support services such as food storage, washing equipment, and wastewater disposal. The form requires detailed information about the owner of the mobile food establishment or ice unit, including their contact details and permit number. Additionally, it gathers comprehensive data about the primary commissary, such as its address, licensing information, and the specific activities it will support, like cooking, food storage, and cleaning. By signing this agreement, the owner not only certifies the accuracy of the information provided but also grants FDACS inspectors permission to assess the commissary's compliance with health and safety regulations during regular business hours. Understanding the importance of this form can help ensure that mobile food operations run smoothly and adhere to state guidelines, ultimately protecting public health and promoting safe food practices.

Form Example

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

Storing of food and dry goods (room temperature)

Yes

Dumping wastewater

Yes

Cold Storage of food (including ice and drinks)

Yes

Receiving potable water

Yes

Cooking and/or reheating food

Yes

Washing the outside of the vehicle

Yes

Three compartment sink

Yes

Restroom facilities

Yes

Other (Describe below)

Yes

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

If yes use as many pages as needed.

FDACS-14223 Rev. 10/15

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⇩ Florida Commissary Letter Of Agreement File

Document Breakdown

Fact Name	Details
Purpose	The Florida Commissary Letter of Agreement form is essential for mobile food establishments and self-vending ice units. It helps ensure compliance with state regulations.
Submission Requirement	This form must be completed and submitted to the Florida Department of Agriculture and Consumer Services (FDACS) as part of the permit application process.
Governing Laws	The form is governed by Florida Statutes Chapter 500, which outlines the regulations for food safety and mobile food operations.
Information Collected	It collects vital information, including the owner's details, commissary information, and the activities that will be conducted at the commissary.
Inspector Access	By signing the form, the owner grants FDACS Food Inspectors access to the commissary for evaluations during normal business hours.

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