WENTZVILLE COMMUNITY CLUB (WCC)

PRE-PACKAGED FOOD SALES PERMIT

Name of Organization_________________________________________

Address____________________________________________________

City_________________________________State______Zip_________

Contact____________________________________________________

Phone: (Cell)_____________(Home)___________(Work____________

***You must provide the following to be considered for approval as a Food Vendor.***

1. Copy of Product Liability Insurance ___Yes ___No

(You must provide a minimum of $2 million in Product Liability Insurance with WCC names as an additional insured)

2. Proof of where product is purchased ___Yes ___No

3. Proof of where product is stored ___Yes ___No

ITEM/PRODUCT FOR SALE: You must be specific. Only listed items will be considered for approval and allowed for sale.

_____________________________________________________________________________________

_____________________________________________________________________________________

(Out-dated, dented, damaged and home canned items are strictly prohibited. Perishable items must be kept refrigerated at all times. There are no exceptions to these rules!)

Date of Event_______________________________________________

Event will occur regardless of weather conditions? ___Yes ___No

You have been made aware of the required St. Charles County Health Dept. Temporary Food Facility Permit and those of the WCC and agree to follow all of those food operating requirements.

___Yes ___No

(Failure to follow these requirements will void your approval as a Food Vendor at WCC)

___________________________________________________________

Signature of Applicant Date

___Approved ______________________________________________

___Not Approved WCC Food Coordinator Date