Mobile Food Vendor Agreement Form

Mobile Food Vendor Agreement Form
Vendor Information
Vendor Company Name*
Vendor Owner/Operator*
Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
On-Site Logistics
Date*

MonthDayYear
Date
Start Time of the Event*

Hour Minutes

AM/PM Option
End Time of the Event*

Hour Minutes

AM/PM Option
Approved Campus Location*
YesNo
Time of Mobile Food Vendor Arrival (setup)*

Hour Minutes

AM/PM Option
Onsite Vendor Operator Name*
Onsite Operator Phone Number:*
University Sponsor Contact Name*
University Sponsors Contact Department/Organization*
Required Documentation
Please attach the following documentation to this form:
County/State Public Health License *

Cancelof
Insurance*

Cancelof
Mobile food vendor operator is responsible for providing a Certificate of Insurance (COI) to the WIU Scheduling and Event Services Office, outlining Commercial General Liability insurance with limits of $1,000,000 per occurrence and $2,000,000 aggregate. The insurance policy shall list the “Western Illinois University Board of Trustees” as an additional insured. The insurance policy shall contain, or be endorsed to state that the operator’s insurance coverage shall be primary insurance as respect to the University.
Vendor Operator Responsibilities
• Mobile Food Vendor Operators must complete and have on file with the WIU Scheduling and Event Services Office or WIU-QC Student Services Office a “Mobile Food Vendor Agreement” form prior to their
arrival to campus property. A Mobile Food Vendor Agreement must be filled out for each campus event where a mobile food vendor is requested.
• Specific to the WIU-QC Campus where food vendors are contracted for consecutive days or for the same recurring time (i.e. every Tuesday), only one agreement is required to be completed. Mobile food vendors must maintain a “self-contained” vehicle with its own power and water sources and cannot connect to a University owned facility or utilize any utility service of the University.
• Mobile food vendor operators must possess a valid and up-to-date food service license through the county or state of Illinois.
• When operating on University Premises, a Mobile Food Vendor must have the ability to present if requested their approved agreement from Western Illinois University and display their designated county and/or state health permit.
• All mobile food vendors must comply with all fire and life safety codes while on campus. Click here for a food truck fact sheet from the National Fire Protection Association (NFPA).
• Mobile food vendor operators must adhere to campus policies on official beverage sponsorships (where applicable), alcohol, tobacco, and noise.
• At the conclusion of the event of activity, the mobile food vendor operator must remove from University premises all forms of waste, recyclables, and compostable products resulting from their presence and located within 100 feet of their assigned location.
• Operators are encouraged to provide recyclable or compostable plate, flatware, and packaging.
• It is the responsibility of the mobile food vendor operator to review the University policy regarding mobile food vending on campus, which can be found at www.wiu.edu/policies or by requesting it through the
WIU Scheduling and Event Services Office.
Vendor Operator Signature
Owner/Operator Mobile Food Vendor*
Date*

MonthDayYear
Date
Printed Name *
Scheduling & Event Services Staff*
I have read and understand the items of responsibility listed above, as well as what is contained in the Western Illinois University Mobile Food Vendor Policy, and I agree to comply with all the requirements and guidelines. I further understand that observed violations of these requirements may result in suspension and/or legal charges being filed.
Should be Empty:

Mobile Food Vendor Agreement Form

Vendor Information

On-Site Logistics

Required Documentation

Vendor Operator Responsibilities

Vendor Operator Signature