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Home My WebLink About02.17.2026 Original Application Ali CITY OF WATERLOO d�erloo Mobile Food Business Application \o The completed application and supporting materials can be mailed to: City Clerk's Office, 715 Mulberry Street, Waterloo, IA 50703;or emailed to For more information,please call the City Clerk's Office at 319-291-4323. Please submit the application, certificate of liability insurance, any required supporting documentation, and application fee no later than fifteen (15) business days prior to starting business. Failure to file a complete application or timely file an application may result in additional fees or a denied application. Write N/A anywhere the information is not applicable to your business. BUSINESS AND LICENSING INFORMATION Today's Date: 1 -a 1-a oo1C Are you applying for a 30 day license: - Are you applying for a 1 year license: X New Application: - Renewal Application: - X — -?5-ac:Qb Start of Business Date:03-o 1- Dates of Operation: (License issued for minimum of 30 days) Business Name:Dc(A n E.(p.Fe-SS \n1u+k/r- i<YJ L I-G Business Address: 115) Corn v•/ci.I 1 Ply t, Wa- r-1o6).TO:-'a 5e) 4� Applicant Name (Photo identification is required): Gc-;Ski- C-CAS+"11 Applicant Address:15 )6 .c c-eS+ Aire kva+ex-i cc 0s,.1 a_ 50?Oa Phone: Cell:563-(AS-0LICI1 Email:d-c'4,Lqd 0A evrt& ce+4.r-)cx)03o r+na jI.G Food Establishment License Number:a ila l'Ayn2 (include copy of license) License Class: Iowa Sales Tax Number:3-Do?-C, 5ok(include copy of permit) or Exemption Number: Insurance Company and Policy Number (Include certificate):S-to,fie sra e re‘. q 5- C a Zia I - MOBILE FOOD UNIT INFORMATION If operating from a vehicle, Driver's License Number: (Must provide copy of valid license) Vehicle identification:-c0co1 aJO a0 PAY / Make Model Year State of Registration License Plate# Vehicle identification:)^tv.-1 'bra;i e,c- (. e.0 )e i v S -0?(D wry )<Z ) 19 Make Model Year State of Registration License Plate # Vehicle identification: Make Model Year State of Registration License Plate# be charged to any applicant that files an incomplete application or fails to timely file the application. A thirty day license is one-hundred dollars ($100) and a one year license is three hundred and fifty dollars ($350). Completed applications and materials may be submitted as follows: 1. Email: clerk@waterloo-ia.org 2. Mail: City Clerk's Office, 715 Mulberry Street, Waterloo, IA 50703 If not a vehicle, describe the Mobile food unit: SPECIFIC NAME, ADDRESS, AND AREA IN WHICH THE BUSINESS IS TO OPERATE: (If proposing to operate on golf course or city park property, include permission from Leisure Services Department) SITE PLAN Amount of space used by the mobile food unit and other movable equipment in square feet: On a separate page, provide a site map of each operating location and on the map draw a box indicating approximately where the mobile food unit will be stationed. EXPLAIN PLANS FOR DISPOSAL OF LIQUID AND SOLID WASTE DIAGRAM OR SKETCH OF THE MOBILE FOOD UNIT IN RELATION TO OTHER MOVABLE EQUIPMENT, INCLUDING TRASH RECEPTACLES. Use the space below to draw a diagram or sketch. One may be provided on a separate sheet of paper and attached to the application. TERMS, CERTIFICATION,AND INDEMNITY AGREEMENT INSURANCE CERTIFICATE: Licensee certifies that a certificate of insurance in conformance with the limits listed in the City of Waterloo Mobile Food Unit Application Guide is hereby attached to this application. FEE: Licensee agrees to pay the applicable application fee at the time the application is filed with the City Clerk's Office. Licensee recognizes that failure to timely file a complete application may result in additional fees. Licensee acknowledges that a $50 inspection fee will be charged for a fire inspection and that all other city fees must be paid in a timely manner to receive and maintain the license. TERM,TRANSFERABILITY, REVISIONS, AND REVOCATION: Licensee understands that a City of Waterloo Mobile Food Business License is only valid for dates listed therein and shall not be transferred to another location, company, or individual. Licensee agrees that if any information in this application changes written notification of the change shall be provided to the City Clerk's Office in writing within three (3) calendar days of the change and that the City Clerk's Office reserves the right to revoke said permit. Permittee agrees that the Mobile Food Business License may be revoked for violating any laws of the City of Waterloo or State of Iowa. CERTIFICATION: I certify that the information contained in the foregoing application is true and correct to the best of my knowledge and belief, that if have read, understand, and agree to abide by the rules and regulations of the proposed event under the City of Waterloo City Code, and I understand that this application is made subject to the rules and regulations established by the City Council. Applicant agrees to comply with all other requirements of city and any other applicable entity that may pertain to the vending of food or beverages. I further certify that I, on behalf of the company, organization or if an individual, myself, am authorized to commit that organization and therefore, agree to be financially responsible for any costs and fees that may be incurred by the mobile food business to the City of Waterloo. I understand and agree that the City of Waterloo may rescind its permission to use city property at any time should it be determined to be in the best interests of the city and its citizens. INDEMNITY AGREEMENT:The undersigned agrees to defend, indemnify and hold harmless the City of Waterloo, its agents, officers, and employees, from and against any and all claims for injury or damages to persons or property arising out of or caused by the use of such property. The undersigned further agrees upon receipt of notice from the City of Waterloo to defend at its own expense the City of Waterloo, its agents, officers and employees from any action or proceeding against the City of Waterloo, its agents, officers or employees arising out of or caused by the use of such property.The undersigned agrees that a judgment obtained in any such action or proceeding shall be conclusive in any action by the City, its agents, officers or employees against the undersigned,when so notified as to the undersigned's cause of the injury or damage, as to the liability of the City, its agents, officers and employees to the plaintiff in the first named action, and as to the amount of the damage or injury. The City of Waterloo, its agents, officers and employees may maintain an action against the undersigned to recover the amount of the judgment together with all the expenses incurred by the City, its agents, officers and employees in the action. I HAVE READ THIS INDEMNITY AGREEMENT, I UNDERSTAND THE EFFECT OF THIS INDEMNITY AGREEMENT, I AM AUTHORIZED TO SIGN THIS INDEMNITY AGREEMENT, AND I AM SIGNING THIS INDEMNITY AGREEMENT VOLUNTARILY. Applicant Name:Cc-;,S-K r C S-(--1(6 Date: ' - a\-aoa-‘ Applicant Signature: k.r,l 1 d ti EC U;- APPLICATION CHECKLIST Is every blank on the application filled in,or have you written N/A where information does not applicable? Have you signed and dated the indemnity agreement? Have you provided a certificate of insurance that conforms to the requirements listed in the guide? Have you provided photo identification? _Have you attached an Iowa State Sales Tax Certificate to the application? I_j�Have you attached a current Food Establishment License to the application? IV/1 r-lave you attached a valid operator's license if operating a motorized vehicle to the application? _Have you attached a picture of the mobile food unit to the application? Have you attached signage to be on display while operating the mobile food business to the application? Have you attached a diagram or sketch of the mobile food unit in relation to other movable equipment, including trash receptacles to the application? Have you included a site map for each vending location,that shows the square footage of your operational area? IMPORTANT CONTACTS Black Hawk County Public Health o Phone:319-291-2413 o Website:https://www.co.black-hawk.ia.us/279/Food-Inspections City Clerk's Office o Phone:319-291-4323 o Email:clerkwaterloo-io.orq Fire Department o Phone:319-291-4460 Leisure Services Department • Phone:319-291-4370 Police Department o Phone:319-291-2515 Planning and Zoning • Phone:319-291-4366 Parking Enforcement o Phone:(319)291-0145 • Email:waterl0000rkinggrepublicparkina.com o Meter Hood Application:Hood Rental Form 1pdf)