Alamat/No.telp. Jenis barang yang akan dijual: Jenis Makanan Yang Akan Dijual: Bersedia untuk berpartisipasi pada tanggal: Minggu, 22 Mei 2016

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1 FORMULIR PENDAFTARAN Indonesian Festival 2016 Ottawa City Hall Jean Pigott Hall 110 Laurier Avenue West, Ottawa, ON K1P 1J1 Minggu Senin, Mei 2016 Nama Alamat/No.telp : : Jenis barang yang akan dijual: Jenis Makanan Yang Akan Dijual: Bersedia untuk berpartisipasi pada tanggal: Minggu, 22 Mei 2016 Senin, 23 Mei 2016 Minggu dan Senin, 22 dan 23 Mei 2016 Menyetujui dan memahami bahwa: 1. Membawa maksimal 2 (dua) peralatan memasak (bagi penjual makanan) seperti kompor, panci elektrik, dll atau peralatan pendukung lainnya dengan total kapasitas 2500 watt guna menjaga ketersediaan listrik bagi seluruh peserta. 3. Menjaga kebersihan area tenda dan lingkungan sekitarnya. 4. Membawa alat pemadam kebakaran guna menjaga keamanan dan keselamatan. 5. Menyetujui dan melaksanakan Food Vendor Regulation dari Pemerintah Ottawa serta Ketentuan Umum dan Tata Tertib Bazaar Kuliner Indonesian Festival 2016 dari Kedutaan Besar Republik Indonesia di Ottawa. Ottawa, 2016 ( )

2 Application Form for Food Vendors at a Special Event Submit or Fax to Ottawa Public Health two weeks prior to event Fax: For further inquiries please contact Toni D'Ettore at ext: 26317, or Shawn Bowers, ext Required fields are marked with an asterisk ( * ) Application Information * Name of organization or business: Name of owner and/or manager (include name of person in charge at event if different than owner/manager): * Street Number: * Street Name: Unit/Apt./Suite: * City: * Postal Code: * Daytime Phone: ext. Evening Phone: ext. * * Name of temporary food premises at the event: Event Information * Name of special event: * Street Number: * Street Name: Unit/Apt./Suite: * City: * Postal Code: Start Date of Event (dd/mm/yy): End Date of Event (dd/mm/yy):

3 Number of days of event: Event Organizer Name: Organizer Phone Number: Location of Food Preparation * Indicate if All food preparation is to be conducted on-site at special event location (i.e. handling, preparation, cooking)? Yes No If No, please continue below. You have 200 words left. Name of food premises: Address of Food Premises Street Number: Street Name: Unit/Apt./Suite: City: Postal Code: Phone Number: Structure Premises Booth Provided by vendor Organizer Location of event Mobile Preparation Premises Outdoor Indoor Describe material for flooring (grass, sand or gravel not acceptable).

4 You have 400 words left. Describe type of structure/covering Umbrella Tent Canopy Other Transportation of Foods *Cold hazardous foods must be maintained at 4 C (40 F) or less and Hot hazardous food must be maintained at 60 C (140 F) or greater at all times, including during transportation. Method of transporting cold foods Cooler with ice packs Method of transporting hot foods Thermal containers Temperature Control Refrigerated truck Cambro unit Equipment for Adequate *Refer to temperature chart in vendor package for proper internal temperatures for cooking, hot holding and cold holding of hazardous foods. Cold holding equipment Refrigeration unit Cooler with ice Hot holding equipment Steam table Cambro unit BBQ/Grill Chaffing dishes Cooking Equipment

5 Stove BBQ/Grill Is the event site serviced (water and hydro available) Yes No Water Source Provided by Vendor Organizer Water Source City Hulled Private Well Handwashing Sink *Please refer to handwash basin requirements. Serviced site Handwashing sink with hot and cold running water Unserviced site Temporary handwashing sink Sinks for Dishwashing *Please refer to dishwashing and utensils requirements. Serviced site Two compartment sink with hot and cold running water Unserviced site Provide an ample supply of clean multi-service utensils Access to a commercial premises for dishwashing throughout the duration of the event Yes No If yes, please continue below. Name of food Premises: Address of Food Premises Street Number: Street Name: Unit/Apt./Suite:

6 City: Postal Code: Power Supply Supplied by Vendor Organizer Electrical hook up Generator Gas Waste Services Garbage pickup responsibility Vendor Organizer Water waste removal responsibility Vendor Organizer Food and Beverage Items Food/Beverage Item (include all samples, free, and sale items) Example: Chili List name of supplier, address and phone number for each food item ABC Restaurant 123 Main Street Ottawa Will the item be pre-cooked before the special event or cooked at special event? Pre cooked

7 Food/Beverage Item (include all samples, free, and sale items) List name of supplier, address and phone number for each food item Will the item be pre-cooked before the special event or cooked at special event?

8 Name of Vendor Signature of Vendor * I hereby certify that the information contained in this application form is accurate. Catatan: Formulir dapat diserahkan kepada Ibu Lenawati atau Ibu Lucie (lucie@indonesia-ottawa.org) selambat-lambatnya pada 13 April Kerusakan dan/kehilangan barang peserta merupakan tanggung jawab masing-masing peserta.

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Please access above link to make online appointment/ Akses tautan di atas untuk membuat perjanjian. _Access website / Akses situs: www.vfsglobal.com/indonesia/norway _Choose Indonesia Flag icon/ Pilih gambar bendera Indonesia _Choose location: Jakarta / Pilih lokasi: Jakarta _Click on Schedule An Appointment