Agreement to sell or serve food

Catering Services

"*" indicates required fields

Are you a PCC staff member?*

Yes

Event information

The Event Coordinator is responsible for completing and submitting this form.

Name of PCC department, club, or co-sponsor*

Name of event*

Name of Event Coordinator*

Event Coordinator's email*

PCC campus and building*

Event Coordinator's PCC phone number*

Event Coordinator's cell number*

Name and address of restaurant or food cart*

25Live reference code

Provide this if you have already requested a room reservation.

How did you advertise?*

Check all that apply.

Flyers

Social media

Invitation only

Other

In what other way did you advertise?*

This agreement is only valid for the date, time, and location specified below

Date of event*

Times of event*

Provide the start and end times for the event.

Location of event*

Provide the campus/center, building, and room number. If the event is in a public space, describe the location.

Name of the "person in charge" during the event*

For a college department or student group, a benefited employee must be the “person in charge” and must be in attendance during the county’s inspection process, and at all times while food is being served.

Description of the food to be served*

Please be specific. For example: pizza, hot dogs, and chips, not just "snacks".

I/We agree to indemnify and defend PCC and its officers, agents, and employees and hold them harmless from and against all liabilities, losses, and costs (including reasonable attorney fees) arising from or relating to the acts or omissions of me/us or our subcontractors, agents, or employees (collectively, "personnel") under this agreement.*

Yes

"Person in charge" signature*

Type your name.

Today's date*

Office phone*

Cell phone*

Submit the following

Submit this form 25 days prior to the event.
Temporary Restaurant License Application: send a copy of paid application and current valid restaurant license, or send a copy of Mobile Unit License for Food Cart to PCC Food Services* 21 days prior to the event.
Food Handler Card for "person in charge": send a copy (country-specific) to PCC Food Services* 21 days prior to the event.
Vendor's Certificate of Liability Insurance with Additional Insured Endorsement (AIE): send an original to PCC Risk Services (attention: risk@pcc.edu) 21 days prior to the event.

* Fax: 971-722-4233 or email: PCC Food Services, foodservices-group@pcc.edu

Questions? Contact the Food Services manager at 971-722-4316.

Phone

This field is for validation purposes and should be left unchanged.