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2. Instructions

   Thank you for your interest in obtaining a Mobile Ice Cream Vendor License in the City of Shaker Heights. Please review the following information before completing the application. Please also take a moment to review Chapter 545 of the Ordinances of the City of Shaker Heights, which regulate mobile ice cream sales in the City.

   
   

   1. You will be required to upload the following information with your application:

   
   

   — Copy of operator's license

   — 2"x2" photo of the operator

   — Proof of insurance

   — Copy of operator's mobile food license

   
   

   We recommend gathering these documents before starting this application.

   
   

   2. After you submit this application, you will be required to get an FBI and BCI background check (i.e. electronic fingerprinting) completed at your cost at the Shaker Heights Police Department.. Click here to learn more about fingerprinting at the Shaker Heights Police Department,

   
   

   3. After review of the application and receipt of the background results, a representative of the Shaker Heights Police Department will contact you to schedule a time for your photo identification card to be made. A $40 fee is due at that time.

   
   

   4. The Mobile Ice Cream Vendor License is valid for the calendar year in which the license was issued. For additional information, please call the Police Information Specialist at 216-491-1220.

   
   

4. Operator Name*
5. Operator Phone Number*
7. Operator Residence Address*
9. Operator Business Address*
11. Is your ice cream truck owned by another business entity?*

    1. Yes
    2. No, I am self-employed.
13. Name of Business Entity that Owns/Furnishes Truck/Franchise.
15. Business Entity Address
16. Business Entity Phone
18. Have you ever been arrested for any criminal offense other than traffic?*

    1. Yes
    2. No
20. If yes, please explain.
22. Have you ever been refused a Solictor’s Permit/License, or had a Permit/License revoked by Shaker Heights or any other municipality or governmental agency*

    1. Yes
    2. No
24. If yes, please explain.
26. VEHICLE INFORMATION
28. Please provide the following information about the vehicle to be used to sell ice cream in the City of Shaker Heights.
30. Make*
31. Model*
33. Year*
34. Registration Number*
36. REQUIRED SUBMISSIONS
38. Please upload the following with your application.
40. Copy of Operator's License*
42. A 2"x2" Photo of the Operator*
44. Proof of Insurance*
46. Copy of Operator's Mobile Food License*
    Must be issued by the Cuyahoga County Board of Health or another authorized Health Department in Ohio.
50. Consent to be fingerprinted and photographed*

    I hereby consent to be fingerprinted and photographed for the purpose of investigation and identification, relative to the issuance of this License, and solemnly swear that the answers given herein have been examined by me and to the best of my knowledge are true, correct and complete.

    1. Yes
    2. No
52. Click here to download instructions for electronic fingerprinting at the Shaker Heights Police Dept.
    
    Please note that not submitting to fingerprinting/photography will result in an automatic denial of your application.
54. Affirmation*

    By checking the "I agree" box below, you agree to the following statement:
    
    I affirm that the information provided in this application is true, correct and complete to the best of my knowledge, and I understand that any false information shall be considered sufficient cause to void this application and could result in criminal prosecution.

    1. I agree
58. Applicant Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that you will fully abide by the Codified Ordinances of the City of Shaker Heights when conducting business in the City. You also agree that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree
60. Electronic Signature
Leave This Blank:


66. 1. Receive an email copy of this form.
67. Email address

    This field is not part of the form submission.

68. Submit

* indicates a required field