Cinco De Mayo Registration Form

Registration Form
REGISTRATION TYPE
First and Last Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com

Business Name
What is your Business Instagram handle
If you don’t have one, type N/A
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Types of products offered
Do you wish to purchase a 1 day policy through our partner Edgar Ortiz CA LIC 4095732?
Loss History - Any prior claims or losses?
Please make sure your insurance matches the sample below.
Otherwise it will be rejected.
ATTACH A COPY OF YOUR CURRENT INSURANCE AND ADDITIONAL INSURED PAGE

IF YOU ARE PURCHASING THROUGH US THEN DISREGARD
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FOOD VENDOR TYPE
Food Truck License Plate Number
Number of Food Handlers On Site
ATTACH YOUR HEALTH PERMIT

MAKE SURE IT WILL BE ACTIVE DURING THE EVENT
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Temporary Food Facility Fees

$82.00 - PREPACKAGED OFF SITE, EITHER COTTAGE OR RESELLERS
$116.00 - PREPACKAGED WITH ANY SAMPLING
$184.00 - PREPARED ONSITE - INCLUDING DRINKS
The County of Los Angeles requires all food vendors to obtain a health permit.

Fees must be paid in advance with this application

A Temporary Food Facility (TFF) application will be emailed to you and must be completed and returned to participate.

We apologize for any inconvenience and appreciate your cooperation.
Fees:

$82.00 – Pre-packaged with sampling

Select this in addition to the Food Pop-up Fee to pay
Fees:

$116.00 – Pre-packaged with sampling

Select this in addition to the Food Pop-up Fee to pay
Fees:

$184.00 – On-site food preparation

Select this in addition to the Food Pop-up Fee to pay

Should be Empty:

Registration Form

EVENT FEES - FOOD VENDORS PLEASE SELECT HEALTH PERMIT FEE IN ADDITION TO EVENT FEE IF YOU DO NOT HAVE AN ACTIVE HEALTH PERMIT WITH LA COUNTY (COTTAGE LICENSE IS NOT EXEMPT FROM FEE)

Credit Card

Registration Form

EVENT FEES - FOOD VENDORS PLEASE SELECT HEALTH PERMIT FEE IN ADDITION TO EVENT FEE IF YOU DO NOT HAVE AN ACTIVE HEALTH PERMIT WITH LA COUNTY (COTTAGE LICENSE IS NOT EXEMPT FROM FEE)*

Credit Card

EVENT FEES - FOOD VENDORS PLEASE SELECT HEALTH PERMIT FEE IN ADDITION TO EVENT FEE IF YOU DO NOT HAVE AN ACTIVE HEALTH PERMIT WITH LA COUNTY (COTTAGE LICENSE IS NOT EXEMPT FROM FEE)