252783MM_Attachment_B_-_DOH_Temporary_Food_Service_Event_Application.pdf
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- Attached to
- Disaster Base Camp Services
- Solicitation number
- 252783MM
- Issued by
- Sarasota County, Siesta Key CDP, Florida
About this file
This is a Temporary Food Service Event Application form issued by the Florida Department of Health under Rule 64E-11.003(7)(a), designed for use by event sponsors and food service vendors operating temporary food establishments in Florida counties. The application requires applicants to provide detailed information about the event, including the applicant and event sponsor contact information, event location, dates and hours of operation, types of food being served, and handwashing facility availability. Vendors must select between two license categories: 1-3 days or 4-18 days, with the restriction that licenses cannot exceed 18 days in a calendar year. The form explicitly prohibits home-prepared foods and requests information about current food service licenses and certified food managers when applicable. By signing the application, representatives agree to comply with Chapter 381.0072, Florida Statutes, and Chapter 64E-11, Florida Administrative Code, and certify that all information provided is true and correct. The document includes a comprehensive directory of Environmental Health offices across all 67 Florida counties, providing specific addresses and contact information for submitting applications and paying temporary event fees.
The application does not specify pricing in the form itself; fees are determined by the county Environmental Health office and must be submitted by check or money order payable to the Florida Department of Health in the appropriate county. Applicants must demonstrate compliance with sanitary standards and food service regulations, with misrepresentation or failure to meet standards serving as grounds for denial or revocation of the temporary food service event license. This application form functions as the foundational licensing document for temporary food service operations during county events and is particularly relevant to the Sarasota County Disaster Base Camp Services contract opportunity, which requires field feeding facilities and services to support deployed disaster responders.
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Text version
DH8004-DCHP- 02/2018
Rule 64E-11.003(7)(a), F.A.C.
STATE OF FLORIDA
DEPARTMENT OF HEALTH
TEMPORARY FOOD SERVICE EVENT APPLICATION
Instructions: 1. Complete the information requested below. 2. Sign the application and return along with required fee to the Environmental Health (EH) office of the County Health Department. NO HOME PREPARED FOODS
Check the appropriate temporary event vendor type (License cannot exceed 18 days in a calendar year): ____1- 3 Days ____4-18 Days
Current Food Service License Number (if applicable): ______________________________________________
Certified Food Manager (if applicable):
APPLICANT NAME: PHONE NUMBER:
APPLICANT ADDRESS:
Street City State ZIP Code
EVENT NAME: ______________________________________________________________________________________________
EVENT SPONSOR: PHONE NUMBER: _______________________
EVENT LOCATION: __________________________________________________________________________________________ Street City State ZIP Code
EVENT DATES & HOURS OF OPERATION: _______________________________________________________________________
TYPE(s) of FOOD BEING SERVED: _____________________________________________________________________________
HANDWASHING FACILITIES: ______ YES ______NO ( ____ HOT & COLD _____HOT ONLY ______COLD ONLY)
LOCATION OF HANDWASHING FACILITIES: _____________________________________________________________________
Comment/Special Instructions: __________________________________________________________________________________
FOR EH USE ONLY: Temporary Event Fee: $_____________
Please make check or money order payable to: Florida Department of Health in _______________ County
The undersigned representative hereby agrees to operate in accordance with the requirements of Chapter 381.0072, Florida Statutes, and Chapter 64E-11, Florida Administrative Code. The information contained in this application, which serves as the basis for licensure, is true and correct. I understand that any misrepresentation to the facts in this application, or failure to comply with sanitary standards, is grounds for denial or revocation of the temporary food service event license.
Signature (Sponsor/Authorized Representative) Date Signature (EH Official) Date
ATTACHMENT B
DOH TEMPORARY FOOD SERVICE EVENT APPLICATION (SAMPLE)
Attachment B - Page 1
Alachua Department of Health in Alachua
County, Environmental Health Section 224 SE 24th Street, Gainesville, FL 32601,
(352) 334-7930
Baker Department of Health in Baker County, Environmental Health
Section, 480 West Lowder Street, Macclenny, FL, 32601,
(904) 259-6291
Bay Department of Health in Bay
County, Environmental Health Section, 597 West
11th Street, Panama City, FL 32401, (850) 872-4660
Bradford Department of Health in
Bradford County, Environmental Health Section, 1801 N. Temple
Avenue, Starke, FL 32091,
(904) 964-7732
Brevard Department of Health in
Brevard County, Environmental Health Section, Government
Center, 2725 Judge Fran Jamison Way, Building A 116, Viera, FL 32940, (321) 633-
Broward Department of Health in Broward
County, Environmental Health Section, 2421 SW 6th Avenue, Fort Lauderdale, FL 33315,
(954) 467-4700
Calhoun Department of Health in Calhoun
County, Environmental Health Section, 19611 State Road 20 West, Blountstown, FL 32424,
(850) 674-5645
Charlotte Department of Health in
Charlotte County, Environmental Health Section, 18500 Murdock Circle, Suite 203, Port Charlotte, FL 33948, (941) 743-1266
Citrus
Florida Department of Health in Citrus County, Environmental
Health Section 3600 W Sovereign Path Lecanto, FL
34461, (352) 527-5295
Clay Department of Health in
Clay County, Environmental Health Section, P.O. Box 578, Green Cove Springs, FL 32043, (904) 278-3782
Collier Department of Health in Collier County, Environmental Health
Section, 3339 E. Tamiami Trail, Suite 145, Naples, FL 34112,
(239) 252-8200
Columbia Department of Health in Columbia
County, Environmental Health Section, 217 NE Franklin Street, Lake City, Florida 32055, (386)
758-1058
Dade (Miami-Dade) Department of Health in
Miami- Dade County, Environmental Health
Section, 1725 NW 167th Street, Miami Gardens, FL, 33056, (305) 623-3500
DeSoto Department of Health in
DeSoto County, Environmental Health Section
34 S. Baldwin Avenue, Arcadia, FL 34266, (863) 993-
Dixie Department of Health in Dixie County, Environmental Health Section, 149 NE 241st Street, Cross City, FL 32628,
(352) 498-1360
Duval Department of Health in Duval County, Environmental Health
Section, 900 University Boulevard N., Suite 300, Jacksonville, FL 32211, (904) 253-1785
Escambia Department of Health in
Escambia County, Environmental Health Section, 1300 West Gregory Street, Pensacola, FL 32501,
(850) 595-6700, ext. 2052
Flagler
Department of Health in Flagler County, Environmental Health
Section, 301 Dr. Carter Boulevard, Bunnell, FL 32110,
(386) 437-7358
Franklin Department of Health in
Franklin County, Environmental Health Section, 137 12th Street, Apalachicola, FL 32329, (850) 653-2113
Gadsden Department of Health in
Gadsden County, Environmental Health Section Physical Address: 278 LaSalle Lefall Drive, Quincy, FL 32353,
(850) 875-7200
Gilchrist Department of Health in
Gilchrist County, Environmental Health Section, 119 NE 1st
Street, Trenton, Florida 32693,
(352) 463-3120
Glades Department of Health in Glades County, Environmental Health
Section, 1021 Health Park Drive, Moore Haven, FL 33471,
(863) 946-0707, ext. 203
Gulf Department of Health in Gulf
County, Environmental Health Section 2475 Garrison Avenue, Port St. Joe, FL 32456, (850)
227-1276, ext. 125
Hamilton Department of Health in
Hamilton County, Environmental Health
Section, 209 SE Central Avenue, Jasper, FL 32052,
(386) 792-1414
ATTACHMENT B
Attachment B - Page 2
Hardee Department of Health in Hardee County, Environmental Health Section, 115 K.D. Revell Road, Wauchula, Florida 33873, (863)
773-4161
Hendry
Department of Health in Hendry County, Environmental Health
Section 3300 Utility Drive, Labelle, FL 33975, (863) 674-4041
Hernando Department of Health in
Hernando County, Environmental Health Section 7551 Forests
Oaks Boulevard, Spring Hill, FL 34606, (352) 540-6800
Highlands Department of Health in
Highlands County, Environmental Health Section, 501 South
Commerce Avenue, Sebring, FL 33870, (863) 402-6550
Hillsborough Department of Health in
Hillsborough County, Environmental Health Section, 1105 E. Kennedy Boulevard, Tampa, FL 33602, (813) 307-
Holmes Department of Health in Holmes County, Environmental Health
Section, 603 Scenic Circle, Bonifay, FL 32425, (850) 547-
Indian River Department of Health in Indian River County, Environmental
Health Section, 1900 27th Street, Vero Beach, FL 32960-
3383, (772) 794-7440
Jackson Department of Health in Jackson
County, Environmental Health Section, 4487 Lafayette Street, Marianna, FL, 32448, (850) 482-
Lafayette Department of Health in Lafayette
County, Environmental Health Section, 140 SW Virginia Circle, Mayo, Florida 32066, (386) 294-
Lake Department of Health in
Lake County, Environmental Health Section, 315 W.
Main Street, Tavares, FL, 32778, (352) 253-6130
Lee Department of Health in Lee
County, Environmental Health Section, 2295
Victoria Avenue, Fort Myers, FL, 33901, (239) 690-2100
Leon Department of Health in
Leon County, Environmental Health Section, 435 N.
Macomb Street, Tallahassee, FL 32301,
(850) 606-8350
Levy Department of Health in
Levy County, Environmental Health Section, 66 West Main Street, Bronson, FL 32621, (352) 253-6130
Liberty Department of Health in
Liberty County, Environmental Health Section 12832 NW Central Avenue, Bristol, FL 32321, (850) 643-
Madison Department of Health in Madison
County, Environmental Health Section, 218 SW 3rd Avenue, Madison, FL 32340, (850) 973-
Manatee Department of Health in
Manatee County, Environmental Health Section, 410 Sixth Avenue, E., Bradenton, FL
34208, (941) 748-0747
Marion Department of Health in Marion County, Environmental Health Section 1801 SE 32nd, Avenue, Ocala, FL 34478, (352) 622-7744
Martin
Department of Health in Martin County, Environmental Health Section 3441 SE Wiloughby Boulevard, Stuart, FL 34994,
(772) 221-4090
Monroe Department of Health in
Monroe County, Environmental Health, Section, 102050 Overseas Highway, Suite 202, Key
Largo, FL 33037, (305) 289-
Nassau Department of Health in
Nassau County, Environmental Health, Section, 96135 Nassau Place, Suite 8, Yulee, FL 32097 (904) 530-6800
Okaloosa Department of Health in
Okaloosa County, Environmental Health, Section, Fort Walton Beach: 221 Hospital Drive NE, Fort Walton Beach, FL 32548, Crestview:
810 E. James Lee Boulevard, Crestview, Florida 32539, Fort
Walton: (850) 833-9247, Crestview, (850) 689-7859
Okeechobee
Department of Health in Okeechobee County, Environmental Health Section 1728 NW 9th Avenue, Okeechobee, FL 34972, (850) 462-5804
Orange
Department of Health in Orange County, Environmental Health
Section, 1001 Executive Center Drive, Suite 200, Orlando, FL
34606, (352) 540-6800
ATTACHMENT B
Attachment B - Page 3
Osceola Department of Health in Osceola
County, Environmental Health Section, 1 Courthouse Square, Suite 1200, Kissimmee, Florida
34741, (407) 742-8606
Palm Beach Department of Health in Palm Beach County, Environmental Health Section, 800 Clematis Street, West Palm Beach, FL
33401, (561) 837-5900
Pasco Department of Health in Pasco County, Environmental Health Section, 5640 Main Street, New
Port Richey, FL 34652, (727) 841-4405
Pinellas Department of Health in
Pinellas County, Environmental Health Section, 8751 Ulmerton Road, Suite 2000, Largo, FL
33771, (727) 507-4336
Polk Department of Health in Polk
County, Environmental Health Section, 2090 E.
Clower Street, Bartow, FL 33830, (863) 519-8330, ext.
Putnam Department of Health in
Putnam County, Environmental Health Section, 2801 Kennedy Street Palatka, FL 32177, (386)
326-7189
Santa Rosa Department of Health in Santa Rosa County, Environmental Health Section, 5527 Stewart Street, Milton, FL 32570, (850)
983-5275
Sarasota Department of Health in
Sarasota County, Environmental Health Section, 1001 Sarasota Center Boulevard, Sarasota, FL
34240, (941) 861-6133
St. Johns Department of Health in St.
Johns County, Environmental Health, Section, 2801 Kennedy Street Palatka, FL 32177, (386)
326-7189
St. Lucie Department of Health in St.
Lucie County, Environmental
Health Section, 5150 NW Milner Drive, Port St. Lucie, FL 34983,
(772) 873-4931
Seminole Department of Health in
Seminole County, Environmental Health Section, 1101 E. 1st Street, Sanford, FL
32771 (407) 665-3604
Sumter Department of Health in Sumter County, Environmental Health Section, 415 E. Noble Avenue, Bushnell, FL 33513 (352) 569
Suwannee Department of Health in
Suwannee County, Environmental Health Section, 915 Nobles Ferry Road, Live
Oak, FL 32064 (386) 362-2708, ext. 243
Taylor Department of Health in Taylor County, Environmental Health
Section, 1215 N. Peacock Avenue, Perry, FL 32347 (850)
223-5125
Union Department of Health in Union County, Environmental Health Section, 495 E. Main Street, Lake Butler, FL 32054 (386)
496-3211
Volusia Department of Health in Volusia County, Environmental Health
Section, 1845 Holsonback Drive, Daytona Beach, FL 32117 (386)
274-0694
Wakulla Department of Health in Wakulla County, Environmental Health
Section, 48 Oak Street, Crawfordville, FL 32327 (850)
926-0400
Walton Department of Health in Walton County, Environmental Health
Section, 362 State Highway 83, DeFuniak Springs, FL 32433,
(850) 892-8021
Washington Department of Health in
Washington County, Environmental Health Section, 1338 South Boulevard, Chipley, FL 32428, (850) 638-6240
ATTACHMENT B
Attachment B - Page 4
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