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1 <br />For all municipal business license questions, contact: Department of Community Investment <br />227 West Jefferson Blvd • Suite 1400 S •South Bend, Indiana 46601 • 574.235.5912 • F: 574.235.9021 <br />LICENSE APPLICATION FOR – MOBILE FOOD VENDOR VEHICLE <br />MUNICIPAL CODE SECTION – 4-45 (SEE ALSO 4-46) <br />I.APPLICATION TYPE Check One:New Renewal <br />II.BUSINESS DATA <br />A.Business Name: <br />B. Business Address: <br />City: State: Zip: <br />C.Mailing Address (If different from above): <br />City: State: Zip: <br />D.Business Telephone Number: <br />E.Business Fax Number: <br />F.E-Mail Address: <br />G.Commissary Name: <br />H.Commissary Address: <br />I.Does the commissary have a valid Food Service Permit: Yes No <br />J.Does 80% of all revenues come from food and beverage sales: Yes No <br />K.Number of employees: <br />L.Insurance Carrier, Agency, and Amount of Liability Insurance: <br />M.Vehicle License Number and Issuing State: <br />N.Vehicle Identification Number (VIN): <br />O.Driver’s License Number and Issuing State: <br />P.Name of Vehicle: <br />Q.Do you plan to park in the Central Business and Entertainment Area (CBEA): Yes No <br />R.Will you be vending from private property: Yes No <br />For Office Use Only <br />Application Filed Fire Dept. Approval <br />Application Fee Paid Health Dept. Approval <br />Sent to Dept. License Fee Paid <br />Building Dept. Approval License Number <br />GIS Identifier MFV Decal Number <br />Not Approved <br />Reason