Homepage Blank Florida Commissary Letter Of Agreement PDF Form
Article Guide

The Florida Commissary Letter of Agreement form plays a crucial role in the regulatory framework for mobile food establishments and self-vending ice units in the state. This form is required to be completed and presented to inspectors from the Florida Department of Agriculture and Consumer Services (FDACS) during the permit application process. It serves as a formal agreement between the mobile food business and the commissary, outlining essential information such as the owner’s contact details, the primary commissary's name and address, and the specific activities that will take place at the commissary. The form includes sections for certifying the accuracy of the provided information and for detailing the types of services the commissary will offer, such as food storage, dishwashing, and wastewater disposal. Additionally, it grants FDACS inspectors the authority to access the commissary during regular business hours for evaluation purposes. The completion of this form is vital for ensuring compliance with health and safety regulations, as it confirms that the mobile food operation has a designated, approved commissary for its operational needs.

Document Preview

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Form Specifications

Fact Name Description
Purpose The Florida Commissary Letter of Agreement form is essential for mobile food establishments and self-vending ice units. It serves as a formal declaration of the relationship between the mobile vendor and the commissary, ensuring compliance with state regulations.
Submission Requirement This form must be submitted to the Florida Department of Agriculture and Consumer Services (FDACS) as part of the mobile food establishment permit application or for a package ice plant self-vending permit application.
Inspection Access By signing the form, the owner grants FDACS food inspectors the right to access the commissary during normal business hours. This is crucial for ensuring that health and safety standards are met.
Governing Laws The form operates under Florida's food safety laws, specifically governed by the Florida Department of Agriculture and Consumer Services regulations, which ensure safe food handling practices.

Florida Commissary Letter Of Agreement: Usage Guidelines

Filling out the Florida Commissary Letter of Agreement form is an important step for mobile food establishments and self-vending ice units. This form needs to be completed accurately and submitted as part of the permit application process. Below are the steps to guide you through the completion of the form.

  1. Begin with Section 1, which focuses on your mobile food establishment or self-vending ice unit information. Fill in your Owner Name and Phone Number, including the area code.
  2. Provide your Owner Mailing Address, including the City, Zip Code (optional), and County.
  3. Enter your Permit Number.
  4. Certify the information by printing your name and signing the form. Also, include the Date of signing.
  1. Move to Section 2, which contains the primary commissary information. Start by entering the Primary Commissary Name and Commissary Address, including the City and Zip Code (optional).
  2. Fill in the County and Primary Phone Number, including the area code.
  3. Provide the Commissary License/Permit Number and Primary E-Mail Address.
  4. Select the appropriate option for Licensed By from the choices provided.
  5. If applicable, enter the On-site Well Permit Number and the name of the Municipal/Utility Supplier.
  6. Complete the section regarding Wastewater Disposal by entering the Septic Tank System Permit Number if relevant.
  1. Indicate the activities you intend to provide at the commissary by answering each question with "Yes" or "No." This includes options like Dish or equipment washing and Cold Storage of food.
  2. If there are additional activities, describe them in the space provided.
  3. Sign the document by printing your name and signing it. Include the Date of signing.
  4. Lastly, indicate if additional commissaries are used. If yes, make copies of the form as needed.

After completing the form, ensure that all information is accurate and clear before submitting it to the FDACS inspector. This will help facilitate the permit application process for your mobile food establishment or self-vending ice unit.

Your Questions, Answered

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

The Florida Commissary Letter Of Agreement form serves as a crucial document for mobile food establishments and self-vending ice units. It must be filled out and submitted to the Florida Department of Agriculture and Consumer Services (FDACS) as part of the permit application process. This form ensures that the food establishment has access to an approved commissary, which is essential for food safety and compliance with state regulations.

Who needs to fill out this form?

Owners of mobile food establishments (MFE) and self-vending ice units (SVIU) are required to complete this form. It is necessary for those applying for a mobile food establishment permit or a package ice plant self-vending permit that mandates the use of a commissary. The owner must provide accurate information regarding their establishment and the commissary they will be using.

What information is required on the form?

The form requires various details, including the owner's name, contact information, and mailing address. Additionally, it asks for the permit number, the primary commissary's name and address, and its contact information. The owner must also indicate the activities they intend to conduct at the commissary, such as washing equipment, storing food, and receiving potable water.

What activities can be conducted at the commissary?

Several activities can take place at the commissary, as outlined in the form. These include washing dishes or equipment, storing food and dry goods, dumping wastewater, cold storage of food, cooking or reheating food, and providing restroom facilities. Owners must check the applicable activities they plan to use at the commissary, ensuring compliance with health and safety regulations.

What happens after the form is submitted?

Once the form is submitted, FDACS inspectors may conduct an evaluation of the commissary during normal business hours. This evaluation ensures that the facilities meet the necessary health and safety standards. Approval of the mobile food establishment or self-vending ice unit permit is contingent upon verification of an approved commissary.

Is there a need to list additional commissaries?

If a mobile food establishment or self-vending ice unit utilizes more than one commissary, the form allows for this. Owners can indicate "yes" to the question about additional commissaries and use extra pages as needed to provide the necessary information. This ensures that all commissaries used are documented and approved.

What should be done if information changes after submitting the form?

If any information provided on the form changes after submission, it is essential to notify FDACS as soon as possible. Changes in ownership, commissary details, or operational activities may affect the permit's validity. Keeping FDACS informed helps maintain compliance with state regulations and ensures the safety of food operations.

How can I contact FDACS for more information?

For additional questions or concerns regarding the Florida Commissary Letter Of Agreement form, individuals can contact the FDACS Bureau of Food and Meat Inspection at (850) 245-5520. This office can provide guidance on the form, the permit application process, and any other related inquiries.

Common mistakes

  1. Incomplete Information: Many people forget to fill in all required fields. Missing details, such as the owner’s phone number or the commissary address, can lead to delays in processing.

  2. Incorrect Permit Numbers: Providing an incorrect permit number can cause confusion. Double-checking the permit number is crucial to ensure it matches the records.

  3. Neglecting Signatures: Failing to sign the form is a common oversight. Both the owner of the mobile food establishment and the person in charge of the commissary must sign to validate the agreement.

  4. Not Specifying Activities: Some applicants forget to indicate which activities will take place at the commissary. Clearly stating activities, such as cooking or washing, is essential for compliance.

  5. Ignoring Contact Information: Providing outdated or incorrect contact information can hinder communication with inspectors. Ensure that the phone number and email address are current.

  6. Failing to Review the Form: Skimming through the form before submission can lead to mistakes. Taking a moment to review all entries can prevent unnecessary complications.

Documents used along the form

The Florida Commissary Letter of Agreement is an essential document for mobile food establishments and self-vending ice units. However, it is often accompanied by several other forms and documents to ensure compliance with state regulations. Below are some of the key documents that are typically used alongside the Commissary Letter of Agreement.

  • Mobile Food Establishment Permit Application: This application is required for any business that operates a mobile food unit. It provides details about the food service operation, including menu items and service locations, and must be submitted to the local health department for approval.
  • Food Safety Plan: A food safety plan outlines the procedures and practices a mobile food establishment will follow to ensure food safety. This includes information on food handling, storage, and sanitation practices to protect public health.
  • Commissary Inspection Report: This report is completed by health inspectors during an evaluation of the commissary. It details the findings regarding compliance with health and safety regulations and is crucial for obtaining and maintaining permits.
  • Proof of Liability Insurance: Mobile food establishments are often required to carry liability insurance. This document serves as evidence that the business is covered for potential damages or injuries that may occur during operations.
  • Employee Training Certificates: Certificates showing that employees have completed food safety training are often necessary. These documents demonstrate that staff members are knowledgeable about safe food handling practices and are compliant with state regulations.

Each of these documents plays a vital role in the operation of a mobile food establishment in Florida. Together, they help ensure that businesses comply with health and safety standards while providing safe food to the public.

Similar forms

  • Mobile Food Vendor Agreement: This document outlines the relationship between a mobile food vendor and a commissary. Similar to the Florida Commissary Letter Of Agreement, it requires details about the vendor and the commissary, ensuring compliance with health regulations.
  • Food Establishment Permit Application: Like the Commissary Letter, this application is necessary for food businesses. It collects information about the establishment and its compliance with health and safety standards.
  • Health Department Inspection Report: This report is generated after an inspection of a food establishment. It shares similarities with the Commissary Letter in that both documents assess compliance with health regulations.
  • Food Safety Management Plan: This plan outlines procedures for maintaining food safety in an establishment. It parallels the Florida Commissary Letter by ensuring that food handling practices meet regulatory standards.
  • Temporary Food Event Application: This application is used for events where food is served temporarily. It is similar in that it requires information about food sources and safety practices, much like the Commissary Letter.
  • Commissary Agreement for Caterers: This agreement details the relationship between caterers and their commissaries. It shares the same purpose of ensuring safe food handling and compliance with regulations.
  • Ice Cream Truck Permit Application: This application is specific to mobile ice cream vendors. It is similar to the Florida Commissary Letter as it also requires a connection to an approved commissary for operations.
  • Food Truck Registration Form: This form registers food trucks with local authorities. It is akin to the Commissary Letter in that it ensures compliance with health regulations and operational standards.
  • Food Handler Training Certificate: This certificate confirms that individuals have completed food safety training. It complements the Florida Commissary Letter by ensuring that staff understand safe food handling practices.
  • Wastewater Disposal Agreement: This agreement outlines how wastewater will be managed by a food establishment. Like the Commissary Letter, it addresses compliance with health and environmental regulations.

Dos and Don'ts

When filling out the Florida Commissary Letter Of Agreement form, it's important to follow specific guidelines to ensure accuracy and compliance. Here’s a list of what to do and what to avoid:

  • Do provide accurate and complete information in all sections of the form.
  • Do double-check the contact information, including phone numbers and email addresses.
  • Do ensure that the owner’s name is printed clearly and matches the official documents.
  • Do specify all intended activities at the commissary, marking "Yes" or "No" as applicable.
  • Do sign and date the form before submission to validate the information provided.
  • Don't leave any sections blank; incomplete forms may delay the permit process.
  • Don't use abbreviations or shorthand that could lead to misunderstandings.
  • Don't submit the form without confirming that all required documents are attached.
  • Don't forget to indicate if additional commissaries are being used; provide extra pages if necessary.
  • Don't assume that verbal communication with the inspector is sufficient; written documentation is essential.

Misconceptions

Misconceptions about the Florida Commissary Letter Of Agreement form can lead to confusion for mobile food establishment owners and operators. Here are six common misconceptions, along with clarifications:

  • This form is only for food trucks. Many believe the form is exclusive to mobile food establishments, but it also applies to self-vending ice units. Both types of operations must comply with the requirements outlined in the form.
  • Submission of the form guarantees permit approval. While the form is essential for the permit application, approval is contingent upon verification of an approved commissary. Incomplete or incorrect information may delay or deny the application.
  • All commissaries are automatically approved. Not all commissaries meet the necessary health and safety standards. The Florida Department of Agriculture and Consumer Services (FDACS) must verify that the commissary complies with regulations before granting approval.
  • Only one commissary can be listed. Some believe they can only use a single commissary. However, if multiple commissaries are utilized, additional pages can be added to the form to provide the necessary information.
  • The form does not require a signature. A common misconception is that the form can be submitted without signatures. Both the owner of the mobile food establishment and the person in charge of the commissary must sign the document to validate the information provided.
  • Activities listed on the form are optional. Some operators think that activities such as food storage or wastewater dumping are optional. In reality, the form requires operators to indicate all activities that will occur at the commissary, ensuring compliance with health regulations.

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

Key takeaways

When filling out and using the Florida Commissary Letter Of Agreement form, keep these key takeaways in mind:

  • This form is essential for mobile food establishments and self-vending ice units seeking permits.
  • Provide accurate and complete information about the owner and the commissary to avoid delays.
  • Certification of the provided information is required; the owner must sign and date the form.
  • The form must be submitted to the FDACS inspector during the permit application process.
  • Indicate all activities that will take place at the commissary, such as food storage and equipment washing.
  • Ensure that the commissary is licensed by the appropriate department, as this affects permit approval.
  • FDACS inspectors have the right to enter the commissary for evaluation during normal business hours.
  • If multiple commissaries are used, additional pages can be included to provide necessary information.