NEW TRUCK VENDOR LICENSE APPLICATION CITY OF GRAMBLING 127 King Street Grambling, LA 71245 Telephone (318) 247-6120 Fax: (318) 247-0940 APPLICANT INFORMATION Name: ____________________________ Title:____________________ Email: __________________________ Cell #: ____________ Address:____________________________ City: _________________ State: ____ Zip:______ Phone #: __________ Fax#: __________
BUSINESS INFORMATION Trade Name: ______________________________ Legal Name: _____________________________________ Mailing Address:______________________________________ City: __________________ State: _____________ Zip:____________ Phone #: __________ Fax#: __________ Website: __________________________ State of Incorporation/organization: ____________ Type of Business: □ Sole Proprietorship □ Partnership □ Corporation □ LLC □ Non- Profit □ Other __________________ FEIN/SS#_________________________ LA. Sales Tax #_______________ Local Sales Tax #______________ Name & Address of Agent for Service of Process:________________________________________________________________________ Liability Insurance Carrier ____________________Policy Number__________________ Expiration Date ______ Policy limits__________
PRODUCT SALES INFORMATION Describe the type of food, beverages, and items to be sold from truck. _______________________________________________________ ________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________
PROPOSED BUSINESS LOCATION □ Rotating within legal parking spaces within City limits in compliance with ordinance and regulations □ Fixed Location on Public Property with Written Approval :_______________________________________________________________ □ Fixed Location with Property Owner Consent:_________________________________________________________________________
VEHICLE INFORMATION Vehicle Type: □Self-Propelled □ 5th Wheel Tow □Bumper Tow □ Trailer □Other (specify)________________________________ Vehicle Make _________________ Vehicle Model ______________ Vehicle Year ________Vehicle Length_____ft. Vehicle Width_____ft. Will Propane (LPG) Tanks be used? □Yes □No If yes, how many? ______ Tank Size _____________Will Generator be used? □Yes □No What type(s) of fuel does appliance(s) use? □Electric □Gas □Propane □ Other ____________ Is Cooking Hood System installed? □Yes □No What type(s) of appliance(s) will be used? □Deep Fryer □Griddle □Stove □Other (Describe) ___________________________________ Person/Entity Listed on Registration ______________________________________ License Plate #_____________ Expiration Date ______ Vehicle Insurance Carrier ___________________Policy Number__________________ Expiration Date ______
CERTIFICATION Applicant swears the statements made on this application and attachments are true and correct to the best of his/her knowledge. I acknowledge that other licenses or permits may be required to legally conduct business in the City of Grambling. I understand that I must report any change in business ownership, operation, and/or address immediately. _______________________________ Signature
__________________________________ Printed Name
_________________ Date
OFFICIAL USE ONLY Date App. Rec’d __________ Fees Rec’d _______ Approved by: ____________________________________________________ Received Copies of: □ La. Secretary of State Certificate/Registration □ La. State Health Permit(s) □ Lincoln Parish and Use Tax Registration Certificate □ Vehicle Registration □ Vehicle Insurance Certificate □ Liability Insurance Certificate □ Photo of Vehicle □ Permission of Property Owner, if applicable □ Written Agreement with Public entity, if applicable
ANNUAL LICENSE FEES: $200.00 Truck Vendor Licenses expire December 31st each year.
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PERMIT FEES. Total Valuation. Fee x 0.65. $1.00 to 1,100.00. $ 36.00. $1,101.00 to 1,200.00. $ 38.50. $1,201.00 to 1,300.00. $ 41.25. $1,301.00 to 1,400.00.
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Permit Package includes but is not limited to: 1. 2 site plans showing location of wall on property. 2. 2 engineered wall details or 1 copy of City Wall Standards. 3. 1 soils report (if required for retaining wall). 4. 1 signed permit application. 5.
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