CHARLOTTE, NC: VENDOR APPLICATION Fill out this application and Fax to:

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1 SOUL FOOD FESTIVAL CHARLOTTE, NC: VENDOR APPLICATION Fill out this application and Fax to: April 26, 2014: Augusta, GA May 10, 2014: Baton Rouge, LA May 17, 2014: Charlotte, NC May 24, 2014: West Palm Beach, FL May 31, 2014: Denver, CO SELECT THE CITY, ONE APPLICATION PER CITY June 7, 2014: Dayton, OH June 14, 2014: Louisville, KY June 21, 2014: Grand Prairie, TX June 28, 2014: Buffalo, NY July 5, 2014: Cleveland, OH July 12, 2014: St. Louis, MO Vendor Information July 26, 2014: Milwaukee, WI August 9, 2014: Hartford, CT August 23, 2014: Kansas City, MO August 30, 2014: Little Rock, AR September 6, 2014: Oklahoma City, OK Name: Address: City: State: Zip: Home Phone: Mobile Phone: Work Phone: Address: Please list any merchandise items that you have available: Do you have any items to fit themed events? (I.e. The Soul Food Festival) Yes No If yes, please list what type(s) Soul Food Festival Vendor Application Page 1 of 4

2 Do you have a tent? Yes No If yes, what are the dimensions? Please bring your own generators for electricity Is Your Booth: (Please check one of the following) Craft Vendor $250 per 10 X 10 space Business Vendor $250 per 10 X 10 space Church Organizations/Civic Group $250 per 10 X10 space Food Vendor $500 per 10 X 10 space FOOD VENDING APPLICATION Please print, fill out and send form to the appropriate city contact above. Vendor Name: Which City are you interested in Vending Address: City: State: Zip: Home Phone: Mobile Phone: Work Phone: Contact Name: Home Phone: Fax Number: Mobile Phone: Work Phone: Sales Tax Number: Address: Menu Items If items exceed list please attach a menu Description of Items Serving Size (oz. pieces) Price per Serving Booth Information (Do not fill this are out, leave blank, promoter will fill out to let you know when your load in/out time will be. Once application is approved we will fax it back to you with this information filled out.) Please bring a money order for clean-up deposit for $250 Date(s) and Time(s) of Event (include Load-In and Load-Out/Clean-Up) Load-In Date: / / Time: : M Load-Out/Clean-Up End Date: / / Time: : M Event Start Date: / / Time: : M Event End Date: / / Time: : M Soul Food Festival Vendor Application Page 2 of 4

3 Vendor Information 1. Food vendors must supply all food service equipment necessary for the operation of their respective booths. 2. Service equipment must be in good working order. 3. Food vendors must obtain all of their supplies and sanitary eating utensils. 4. Rented tents must be clear of all soot, grease, and debris at the conclusion of the event. 5. Food vendors will be provided with one trash barrel for use within their respective tents. 6. Each participant will be responsible for providing trash bags for trash disposal. 7. Equipment brought onto the site shall be in good working order. All equipment shall have an equipment ground. 8. Food vendors will supply the following information for every piece of equipment requiring electrical connection one week before the date of the event. The Soul Food Festival will not provide electricity. You must bring your own generator in good working condition and updated. a. Voltage (e.g., 120 volts, 208 volts, 240 volts) Watts (e.g., 900 watts, 1200 watts, 3,000 watts) 9. b. This information may be found on the manufacturer's nameplate. The Soul Food Festival doesn't supply neither extension cords nor multiple-outlet receptacles. Food vendors must provide lighting and extension cords. All electrical needs will be listed on the application. Food vendors using bottled gas must adhere to all restrictions specified by the Fire Marshall. 10. Food vendors using grease in their operation, or producing grease by-prodct if their operation must use grease receptacle provided. Any food vendor found dumping grease on the ground, or any other area on the event property will bear the cost and responsibility of cleaning up the grease may have caused paying for any damage. 11. The Soul Food Festival will determine the locations of each booth. 12. All food vendors must have at least one CO2 fire extinguisher in the booth at all times. 13. All food vendors must be completely set up for inspection at least 30 minutes prior to the start of the event. All vehicles at that time must be removed from the park. Failure to comply will be grounds for immediate dismissal or prohibition from future participation. 14. There will be no open fires. General Guidelines & Information for Special Event Vending 1. Food vendors who apply and are selected must meet the guidelines established by the Soul Food Festival Office of Special Events. Please see important disclaimer at the bottom of this page 2. Only full-service restaurants, fast food, and licensed food vendors will be considered for participation in any Soul Food Festival Special Events. 3. Vendors must adhere to all rules and regulations set forth in this document and the hosting City Ordinances. 4. All food vendors who do not have an annual license will need to apply for and purchase a temporary event license on site at the event. 5. Food vendors will be required to show proof of Comprehensive General Liability policy with liability limits $1,000,000 per occurrence and $1,000,000 aggregates. The Soul Food Festival must be named as additional insured on these policies as follows: Certificate holder is listed as additional insured on General Liability Policy as Soul Food Festival PO Box Midwest City OK and list the city you will be vending in. 6. The Soul Food Festival must receive certificates of insurance with the vendor application. Soul Food Festival Vendor Application Page 3 of 4

4 7. All vendors who have three (3) or more employees must provide a copy of Workers Compensation Insurance with liability limits of $100, All vendors are required to show proof of Automobile Insurance on all owned or hired automobiles with liability limits of $100,000/$300,000 or $500,000 CLS. 9. Participating food vendors must comply with the rules and regulations of the hosting State's Health Department and any other governmental body with jurisdiction over any Soul Food Festival event. 10. Food vendors must be identified at any Soul Food Festival special event by name used at the principal place of business. 11. Only approved food items as listed on the application may be sold. Participants may sell no items such as t-shirts, cups, aprons etc. during the event without written approval of the Soul Food Festival Coordinator. 12. The Special Events Director must approve any promotional items given away at the event in advance. 13. No roaming will be permitted during any event. 14. Trailers will be considered for events, please provide picture with application. 15. No items may be served in a glass container of any kind. 16. The event committee will review applications; specific foods must be listed on the application to ensure a balanced selection of menu items per vendor. 17. *The Soul Food Festival of Special Events recruits and registers vendors for each of our events. If someone other than the Soul Food Festival contacts you about vending at Soul Food Festival events, please be aware that he/she may be selling fraudulent vendor placements. Any vendors not registered through the Soul Food Festival will not be permitted at Soul Food Festival Special Events. Any person(s) found to be selling fraudulent vendor spots for Soul Food Festival Special Events will be prosecuted to the fullest extent of the law. Menu Guidelines 1. Participants will NOT be allowed to serve or sell any non-alcoholic or alcoholic beverages at any Soul Food Festival Special Events including smoothies, ice cream, shaved ice, ice etc. without strict permission from the Soul Food Festival. 2. The majority of food preparation should take place at the food vendor's normal place of business. Specialties should be "finished off" at the site of at the event site. Fees & Costs 1. There is a flat fee to participate in any Soul Food Festival Special Events. 2. Participating food vendors are responsible in providing their own tents, chairs, tables etc. 3. Participants will be responsible for securing and/or paying for any special permits that may be required by the Soul Food Festival or any other governmental agency. 4. The Soul Food Festival is looking forward to a profitable venture for all participants. Food vendors will keep 100 percent of sales. Electrical Services Each Vendor will have to provide their own Generators. Soul Food Festival Vendor Application Page 4 of 4

5 Mecklenburg County Health Department Temporary Event Organizer Application This application must be completed and submitted to the Mecklenburg County Health Department (MCHD) to provide information about all food preparation and sales to the public at any public event or exhibition within Mecklenburg County. In addition to this organizer application, a separate Food Vendor Application must be submitted by each food service vendor participating in the event or exhibition. This application must be submitted with a map of the event site indicating the location of all of the food booths. Please Note: This application, map, and Food Vendor Application(s) must be submitted no later than 15 days prior to the event. A fee of $75.00 will be required for each food service permit and must be paid with the submission of each Food Vendor Application. 1) Name of Event: Date of Event: 2) Address of Event: NC Street City State Zip 3) Event Date(s): 4) Organizer Name: Organizer Phone: 5) Organizer Address: Street City State Zip 6) Additional Organizer Contacts: Additional Phone: 7) Organizer 8) Number of Anticipated Food Booths: 9) Date/Time of Food Booth Set Up: 10) Source of Water for Food Booths (check the box which applies for all food vendors): Public Water Supplied by Organizer Water Supplied by Food Vendor On-site Private Well (requires testing by MCHD) Other: 11) Check the following items supplied for the food booths by the organizer: Electricity Refrigeration Toilet Facilities Drinking Water Hose(s) Recycling Garbage Pick-up Grease Disposal Waste Water Disposal 12) Will the event include a petting zoo or pony rides? Yes* No *If yes, how many hand wash facilities will be available? I certify that the information in this application is complete and accurate. I understand that any changes to my operation must be submitted to the Mecklenburg County Health Department for review and approval prior to the day of the event: Organizer Signature: Date: Submit this application, all Food Vendor Applications, permit fee(s) and event map to: Mecklenburg County Health Department, 700 North Tryon St., Ste. 208, Charlotte, NC Phone: (704) Revised 01/14/ N. Tryon St., Ste. 208, Charlotte, NC (704) AJM, REHS

6 Mecklenburg County Health Department Temporary Food Event Vendor Application This application must be completed and submitted to the MCHD (Mecklenburg County Health Department) to provide information about all food preparation and sales to the public at any public event or exhibition within Mecklenburg County. Applications must be submitted no later than 15 days prior to the event. Please Note: A fee of $75.00 will be required for each food service permit and must be paid with the submission of each Food Vendor Application. 1) Name of Event: Date of Event: 2) Address of Event: NC Street City State Zip 3) Name of Vendor: Vendor Phone: 4) Vendor Business Name: 5) Vendor Business Address: Street City State Zip **Please note: food booth must be completely set up prior to permitting and NO food preparation is allowed in the booth until the permit is issued** 6) Date for permitting: 7) Time for permitting: 8) Applicant Address: 9) Will vendor prepare food prior to the event? Yes No If you checked yes food will be prepared prior to the event*, provide the name of the facility where food will be prepared: Name of Prep Facility: Date of preparation: Time of Preparation: Address of Prep Facility: Street City State Zip *Please Note: Advanced preparation may require a permit by MCHD for the preparation site. 10) As of September 1, 2012, the vendor/permit holder shall require all food service employees to comply with an approved Employee Health Policy. Do you have an approved Employee Health Policy? Yes No 11) Please check the box that best describes the source of water for your food booth: Public water supplied by organizer (requires food grade hose) Tap water supplied by vendor On-site private well (requires sampling by MCHD) Bottled water supplied by vendor 12) Check the box that best describes the disposal method for the following: Garbage: Wastewater: Grease: Waste can taken offsite Portable toilet at event Grease taken offsite Event dumpster Event grey water bin Event grease receptacle Other: Other: Other: 13) Check the box that best describes your equipment: Cold Holding: Hot Holding: Utensil Washing: Hand Washing Set-up Refrigerated truck Chafing dishes 3 Utility sinks Mechanical sink Commercial refrigerator Electric hot box 3-compartment sink Gravity flow set-up Freezer Grill 3 Basins Other: Other: Other: Other: Revised 01/14/ N. Tryon St., Ste. 208, Charlotte, NC (704) AJM, REHS

7 14) Will ready-to-eat produce (vegetables or fruit) be prepared in your food booth? Yes (requires a prep sink) No 15) Provide a complete list of all food/menu items in the chart below and check Advanced Preparation if the food/menu item will be prepared prior to the event or check Prepared at Event if no advance preparation is needed. Check both Advanced Preparation and Prepared at Event if food/menu item requires both types of preparation. Please include all add-on items such as lettuce, tomato, onion, etc. (example: Hamburgers with cheese, lettuce, tomato, onion). Food/Menu Items Advanced Preparation* Prepared at Event *Please note: food preparation may not exceed more than 7 days prior to the event. 16) Check the box which describes your food booth set up: 3-sided tent Tent with fans Mobile food unit Other: 17) Find the following example of a typical food booth set-up. Please note that ALL food booths must have approved hand wash set-up and utensil washing set-up for washing, rinsing and sanitizing equipment. Other equipment needs may vary. 3 Sided 10 x20 Tent Chest Freezer Grill Pot for Heating Water Table for Dry Storage Buckets for Waste Water Produce Washing Sink 3 Basins for Utensil Washing/Rinsing/Sanitizing Table Space for Air-drying Utensils Tea Urn for Hand- Washing Cashier s Area Table for Public Barrier Table for Public Barrier I certify that the information in this application is complete and accurate. I understand that: Any changes to my operation must be submitted to the Mecklenburg County Health Department for review and approval prior to the day of the event All potentially hazardous foods (PHF) that I am serving must be maintained at approved temperatures (45 F or below for cold food and 135 F or above for hot food) during transport, holding and/or service Failure to maintain approved temperatures for PHF may result in disposal or embargo of the food Applicant Signature: Date: Office Use Only Reviewer Signature: Date: Comments:

8 Mecklenburg County Health Department Checklist for Temporary Food Establishment Vendors The following is a checklist to assist a vendor in setting up a Temporary Food Establishment (TFE). All items on the checklist are necessary to obtain a permit for a TFE; however, additional requirements may be applicable. All applications must be submitted to the Mecklenburg County Health Department (MCHD) at least 15 days prior to the date of the event. Person in charge Food safety education certification Available during all hours of food preparation Employee requirements Gloves Employee Health Policy Agreement Hat, hair net or visor Tent/weather proof structure/canopy Canopy over entire operation (smokers are not required to be under a canopy) Fly protection 3 solid or mesh sides Fly fans Ground covering Protection from dust/mud (in the absence of asphalt, concrete or grass) Water supply Approved water source (requires testing by MCHD if private well) Drinking water hose(s) must be labeled A means to heat water Waste water disposal Buckets/grey water containers must be labeled Disposal in approved sewage system or porta-johns Utensil washing 3 basins (large enough to fit equipment) Drain board or counter space for air drying Soapy water, rinse water, sanitizer Sanitizer test strips Hand washing station At least 2 gallons of hot water under pressure Free-flowing faucet/stopcock Soap and disposable towels Wastewater catch bucket must be labeled Approved/protected/secured food Approved source/food invoices Food storage above ground Separate vegetable washing sink (when preparing/serving ready-to-eat vegetables) Food temperatures Accurate food thermometer Cold holding: refrigeration/freezer/coolers with ice Hot holding equipment Food shields/customer barriers No food exposed to customers Approved self-service condiments Lighting (for night-time operations) Shielded above food/preparation I certify that I will comply with the requirements listed above and any other requirements as described by MCHD while operating my Temporary Food Establishment: Vendor Signature: Date: February 12, N. Tryon St., Ste. 208, Charlotte, NC (704) AJM, REHS

9 Employee Health Policy Agreement Reporting: Symptoms of Illness I agree to report to the manager when I have: 1. Diarrhea 2. Vomiting 3. Jaundice (yellowing of the skin and/or eyes) 4. Sore throat with fever 5. Infected cuts or wounds, or lesions containing pus on the hand, wrist, an exposed body part (such as boils and infected wounds, however small). Reporting: Diagnosed Illnesses I agree to report to the manager when I have: 1. Norovirus 2. Salmonella Typhi (typhoid fever) 3. Shigella spp. infection 4. E. coli infection (Escherichia coli O157:H7 or other EHEC/STEC infection) 5. Hepatitis A Note: The manager must report to the Health Department when an employee has one of these illnesses. Reporting: Exposure of Illness I agree to report to the manager when I have been exposed to any of the illnesses listed above through: 1. An outbreak of Norovirus, typhoid fever, Shigella spp. infection, E. coli infection, or Hepatitis A. 2. A household member with Norovirus, typhoid fever, Shigella spp. infection, E. coli infection, or hepatitis A. 3. A household member attending or working in a setting with an outbreak of Norovirus, typhoid fever, Shigella spp. infection, E. coli infection, or Hepatitis A. Exclusion and Restriction from Work If you have any of the symptoms or illnesses listed above, you may be excluded* or restricted** from work. *If you are excluded from work you are not allowed to come to work. **If you are restricted from work you are allowed to come to work, but your duties may be limited. Returning to Work If you are excluded from work for having diarrhea and/or vomiting, you will not be able to return to work until more than 24 hours have passed since your last symptoms of diarrhea and/or vomiting. If you are excluded from work for exhibiting symptoms of a sore throat with fever or for having jaundice (yellowing of the skin and/ or eyes), Norovirus, Salmonella Typhii (typhoid fever), Shigella spp. infection, E. coli infection, and/or Hepatitis A, you will not be able to return to work until Health Department approval is granted. Agreement I understand that I must: 1. Report when I have or have been exposed to any of the symptoms or illnesses listed above; and 2. Comply with work restrictions and/or exclusions that are given to me. I understand that if I do not comply with this agreement, it may put my job at risk. Food Employee Name (please print) Signature of Employee Date Manager (Person-in-Charge) Name (please print) Signature of Manager (Person-in-Charge) Date

10 These are some of the Bacterium and Viruses spread from Food Handlers to Food E. Coli Overview: A bacterium that can produce a deadly toxin and causes an estimated 70,000 cases of foodborne illnesses each year in the U.S. Sources: Meat, especially undercooked or raw hamburger, produce and raw milk. Incubation period: 2-10 days Symptoms: Severe diarrhea, cramping, dehydration Prevention: Cook implicated food to 155F, wash hands properly and frequently, correctly wash rinse and sanitize food contact surfaces. Ways of Prevention 1. Handwashing is the MOST CRITICAL control step in prevention of disease Invest 20 seconds to follow these 6 simple steps: 1. Wet your hands and arms with warm running water. 2. Apply soap and bring to a good lather. 3. Scrub hands and arms vigorously for 10 to 15 seconds (clean under nails and between fingers). 4. Rinse hands and arms thoroughly under running water. 5. Dry hands and arms with a single-use paper towel or warm-air hand dryer. 6. Use the towel to turn off faucets and open door handles so you don t recontaminate your hands 2. Don t go to work when you are sick 3. No bare hand contact with ready-to-eat foods. Shigella Overview: Shigella is a bacterium that causes an estimated 450,000 cases of diarrhea illnesses each year. Poor hygiene causes Shigella to be easily passed from person to person. Sources: Salad, milk, and dairy products, and unclean water. Incubation period: 1-7 days Symptoms: Diarrhea, stomach cramps, fever, chills and dehydration Prevention: Wash hands properly and frequently, especially after using the restroom, wash vegetables thoroughly. Salmonella Overview: Salmonella is a bacterium responsible for millions of cases of foodborne illnesses a year. Elderly, infants and individuals with impaired immune systems are at risk to severe illness and death can occur if the person is not treated promptly with antibiotics. Sources: raw and undercooked eggs, undercooked poultry and meat, dairy products, seafood, fruits and vegetables Incubation period: 5-72 hours (up to 16 days has been documented for low doses) Symptoms: Nausea, vomiting, cramps, and fever Prevention: Cook all food to proper temperatures, chill food rapidly, and eliminate sources of cross contamination (i.e. proper meat storage, proper wash, rinse, and sanitize procedure) Hepatitis A Overview: Hepatitis A is a liver disease caused by the Hepatitis A virus. Hepatitis A can affect anyone. In the United States, Hepatitis A can occur in situations ranging from isolated cases of disease to widespread epidemics. Incubation period: days Symptoms: Jaundice, nausea, diarrhea, fever, fatigue, loss of appetite, cramps Prevention: Wash hands properly and frequently, especially after using the restroom. Norovirus Overview: This virus is the leading cause of diarrhea in the United States. Any food can be contaminated with norovirus if handled by someone who is infected with the virus. This virus is highly infectious. Incubation period: 6-48 hours Symptoms: Nausea, vomiting, diarrhea, and cramps Prevention: Wash hands properly and frequently, especially after using the restroom: obtain food from a reputable food source: and wash vegetables thoroughly. Staph (Staphylococcus aureus) Overview: Staph food poisoning is a gastrointestinal illness. It is caused by eating foods contaminated with toxins produced by Staphylococcus aureus. Staph can be found on the skin, in the mouth, throat, and nose of many employees. The hands of employees can be contaminated by touching their nose, infected cuts or other body parts. Staph produces toxins that are extremely heat stable and are not inactivated by normal reheating temperatures. It is important that food contamination be minimized. Incubation period: Staph toxins are fast acting, sometimes causing illness in as little as 30 minutes after eating contaminated foods, but symptoms usually develop within one to six hours. Sources: Ready-to-eat foods touched by bare hands. Foods at highest risk of producing toxins are those that are made by hand and require no cooking. Symptoms: Patients typically experience several of the following: nausea, vomiting, stomach cramps, and diarrhea. The illness lasts one day to three days. In a small minority of patients the illness may be more severe. Prevention: No bare hand contact with ready-to-eat foods. Wash hands properly. Do not prepare food if you have a nose or eye infection. Do not prepare or serve food for others if you have wounds or skin infections on your hands or wrists. If food is to be stored longer than two hours, keep hot foods hot (over 135 F) and cold foods cold (41 F or under). Properly cool all foods.