Form

Required fields are marked with asterisks (*)

Refreshment Vehicle Special Event

Application Form

All refreshment vehicles attending special events within the Municipality of Kincardine must complete the following form.

Name of Applicant/Firm:

Contact Name:

Mailing Address:

Postal Code

Phone No.

Email address:

Event Name:

Date of Event

Attach a current Food Premises Inspection Report, R.R.O. 1990, Regulation 562

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Attach a Mobile Food Service Equipment (MFSE) Annual Inspection Certificate for MFSE's from the Technical Standards & Safety Equipment (TSSS)

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Attach insurance certificate (minimum $2,000,000 liability insurance with the Municipality of Kincardine named as an additional insured)

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Attach Fire Department Certification

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We/I have read the eligibility criteria and confirm that the organization will comply with all requirements set out in By-law 2019 - 008.

Signature (use your mouse or touchpad to sign in the box below)

Clear

Date

Personal information collected under the authority of the Municipal Act, 2001, S.O. 2001 c. 25 and will be used for the purpose of creating a record to determine eligibility for a municipal Refreshment Vehicle Licence. Questions about this collection should be addressed to the Clerk of the Municipality of Kincardine at 1475 Concession 5, RR #5, Kincardine ON N2Z 2X6, 519-396-3468

Contact(s)