BertramPrimary School Fair

Champion Drive, Bertram

2:30pm – 7:00pm Friday, March 11th 2016

For stall registrations or general enquiries email

Food Stall - $50 per 3m x 3m site – stallholders to provide tables, chairs & shelter

Bookings for food stalls must be received with full payment by Friday February 5th 2016.

The attached City of Kwinana paperwork MUST be completed and returned to the Town of Kwinana no more than 28 days prior to the event. Payment is at the discretion of the council.

Business/Individual name: ______

Full name of contact person: ______

Contact details: Phone ______Email ______

Residential Address: ______

Mobile vehicle / temporary stall? Yes / No Vehicle Registration number if mobile: ______

Description of items for sale: ______

Tastings offered? Yes / No

Name of insurance company: ______

Name on policy: ______

Policy number: ______Policy renewal date: ______

Erecting a marquee? Yes / No If Yes, size of the marquee: ______

Undercover Area or shelteredsite requested? Yes / No (subject to availability)

Number of adjacent 3m x 3m sites requested: ______sites @ $50 per site

Payment by cash / cheque / eftpos / credit card

Cash: Pay at the front office when you submit your booking form.

Cheque: Pay at the front office or post with your booking form.

Eftpos: Pay at the front office when you submit your booking form.

Credit Card: Pay at the front office, by phone or post the attached slip with your booking form.

Bertram Primary School contact details:

Postal address: Champion Drive, Bertram, WA 6167

Phone: 94191762

Email:

Bertram Primary School 2015 Fair - Credit Card Payment- Food Stall Booking
Card No.
Name: ______Contact Number: ______
Mastercard / Visa Expiry Date ______Amount ______
Name on Card ______
Signature of Cardholder: ______Date: ______

Authority Register No.______(TIPP)

Trading in Public Places Application

For Temporary or Mobile Food Businesses with existing notification or registration

  • If the food business had not been issued with a current verification of notification or certificate of registration under the Food Act 2008, please complete an Application for Notification/Registration of Food Business and Trading in Public Places Licence for Mobileor Temporary Food Businesses
  • Each temporary food stall or mobile food vehicle/ unit will require a separate application.

Section 1. Food Business Details

Trading Name:
Organisation Name: / ABN:
Postal Address:
Phone: / Fax: / Email:
Details of Public Liability Insurance (attach a copy):

Section 2. Proprietor’s Details (the Proprietor is the person who conducts or is in charge of the food business)

Proprietor’s Full Name (person’s name):
Proprietor’s Residential Address: / Unit no. / Street no. / Street name
Suburb / Postcode
Phone: / Mobile:
Fax: / Email:

Section 3. Details of Event or Location(s) of Trading

Event Name (if applicable): Bertram PS Fair
Location(s) of Proposed Trading (submit site plan): To be advised on Site Plan submitted by School
Proposed Date/s of Operation: Friday 13 March 2015
Proposed Hours of Operation: 2.30pm to 7pm
Number of Food Handlers:

Section 4. Temporary Food Premises or Mobile Food Premises Details

 Temporary Food Stall (describe stall fixtures, equipment and fittings)
______
  • The stall is  Covered with marquee/ tent  Inside a building  Uncovered
 Other (please specify______)
  • If covered with marquee/ tent, please indicate size of the structure ______
  • Type of floor covering (if on unsealed ground) ______
 Mobile Food Vehicle/ Unit
  • Vehicle Make ______Model ______Registration Number: ______

Is the temporary food premise or mobile food vehicle/ unit Notified Registered
notified or registered with a local council?
  • Notification/ Registration Certificate Number: ______
(Attach copy of the verification of notification/ registration certificate)
  • Local Council where notification/ registration is held: ______

Types of food to be sold or given away:
 Hot cooked/ reheated food List food: ______
 Cold prepared food List food: ______
 Drinks/ beverages List food: ______
 Pre-packaged low risk foods List food: ______
 Other List food: ______
Section 5. Facilities available at the temporary food premises
How will Perishable Food be Stored on Site?
 Refrigerator/ freezer On ice in eskies
 In a Bain-marie prior to sale Cooked & Sold with Demand
Where is the Food being Prepared?
On site  Inside mobile food vehicle/ unit In my residential kitchen*
 In an approved residential/ commercial kitchen
(Please specify contact person’s name ______and contact phone no. ______Residential/ commercial kitchen address ______)
*Preparation in residential kitchen is only permitted for once-off charitable or community event where low risk or shelf stable food (not potentially hazardous) is prepared
Power Supply
External Supply Self Contained Generation Not Required
Water Supply
Self Contained Storage Mains Other (please specify______)
Waste Water Disposal
Self Contained Storage Container for waste water
 External Disposal (please specify______)
Details of Hand washing Facilities (tick all that apply):
Hand basin with warm water supply by from water-heating device (e.g. urn)
Hand basin connected to mains with warm water supply connected to mains
Liquid soap and single use paper towels provided with dispenser installed
Liquid soap and single use paper towels provided next to hand-washing facility
Other (please specify ______)

PLEASE NOTE: The following 4 information items MUST be provided in writing with this application, or it will not be processed.

1. Copy of public liability insurance certificate of currency

2. Copy of notification/ registration licence if notified/ registered with a different local council

3. A copy of detailed floor plan and site plan

Floor plan should show

  • details of the layout of equipment, food display and tables;
  • location of handwash basins, utensil washing facility and water-heating device (e.g. urn);
  • storage of potentially hazardous foods (e.g. esky, bain-marie); and
  • location of waste water disposal and refuse storage areas.

Site plan to show location of proposed trading (if permanently stationed)

4. Written permission from the owner of the land to trade at proposed location(s)

Declaration:

I, ______(name of the proprietor) making this application declare that the information contained in this application is true and correct in every particular.

Signature of proprietor:Date:

TRADING IN PUBLIC PLACE LICENCE FEES (all fees applicable as indicated below):

Note: Fee Increases may apply 1 July each financial year.

Application fee $29 (96)

Inspection fee $61 (132)

Periodic fees $24 (daily fee) (134) $99 (1 week) (135) $210 (1 month) (150)

$313 (3 months) (365) $417 (6 months) (136) $800 (12 months) (137)

S:\AdminShared\All Staff\Bertram Fair\2015 School Fair\Booking forms\Bertram PS Fair Stall FOOD STALLS.doc