1. No category

COURTESY TRANSLATION
(S.C.I.A) CERTIFIED DECLARATION OF BUSINESS START UP
OF TEMPORARY SALE/SERVING OF FOOD AND DRINKTO THE PUBLIC - EVEN FREE OF CHARGE
FOR THE DURATION OF THE EVENT EXPO MILANO 2015
(MAY 1 TO OCTOBER 31, 2015)
To the Municipality of MILAN
1
Pursuant to Regional Laws No 11/2014 and 33/2009 and to Legislative Decree No 78/2010 converted into Law No 122/2010
The undersigned _________________________________________________________________________
(name and surname)
fiscal code/VAT number/ID Number
born in ____________________________ resident in ___________________________________________
street ________________________________ n. _____ ZIP _______ Country_________________________
tel. ____/_________ fax ____/_________ e-mail _______________________________________________
citizenship______________________________ (specify citizenship)
As:
 Commissioner General of Section (Official Participant) or Director (Non-Official Participant)
representative of__________________________________ (name of Participant) at Expo Milano 2015
 Appointed representative of ____________________________ (name of Participant) at Expo Milano 2015*
* Use of the Power of Attorney is optional. The Power of Attorney must be attached.
(or, alternatively)
As:
 Owner
 Legal representative
 of the sole Proprietorship
 Other __________________________________________
 of the Enterprise/ Company/Entity
Trade or Company name: ___________________________________________________________
Fiscal code
VAT number (if different from
Fiscal Code)
With registered offices in _____________________ St. ________________________ n. _____ ZIP ___________
tel. ____/_________ fax ____/_________ e-mail ______________________________________________
 Enrolled in business Register of C.C.I.A.A (Chamber of Commerce) of_________
n. ___________________
Aware of the criminal and administrative consequences provided for by arts. 75 and 76 of Decree of the
President of the Republic (DPR) No 445/2000 for false declarations and creation or use of false documents
GIVES NOTICE OF THE START OF THE
2
 Activity of temporary retail sale of non-food products
 Activity of temporary retail sale of food products
 Activity of temporary preparation and serving of food and drinks
 Activity of temporary preparation of food and drinks
 Activity of temporary serving of food and drinks prepared out of the site
 Activity of temporary free tasting of food and drinks for the public
Page 2 of 6
3
INFORMATION CONCERNING FOODS THAT WILL BE USED FOR THE ABOVE INDICATED ACTIVITIES
(multiple answers allowed):
Products produced/offered for sale
 Loose products
 Packaged products
Do the products marketed require temperature controlled storage?
 YES (refrigeration)
 YES (freezing/deep freezing)
 NO (can remain at ambient temperature)
 (if YES) list of the main refrigerating equipment ___________________________________________________
___________________________________________________________________________________________
Merchandise Description
 Animal origin products (describe the animal species and the types of animal origin products, for example for
fresh meat indicate lamb, beef, pork etc ; for transformed products indicate: cured meats, preserves etc.):
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
 Non animal origin products: ________________________________________________________________
___________________________________________________________________________________________
 Novel Food :_______________________________________________________________________________
___________________________________________________________________________________________
Preparation methods
 preparation (extemporaneous) with immediate consumption;
 delayed consumption with preparation carried out:
 at the site where serving/sale takes place;
 at a different site:
(indicate the site) street ___________________________________________ n. _____ ZIP ________
With the following methods of transport of the product:
 vehicle with refrigeration system
 vehicle with heat maintaining system (T > 65°C)
 other
Page 3 of 6
CHARACTERISTICS OF THE ACTIVITY SUBJECT OF NOTIFICATION
4
Site where the activity takes place:

INSIDE the Expo Milano 2015 Exhibition Site
4A
in a structure identified by the plans – both general and specific – attached to the this
declaration, situated at:
 Lot n.
_________________
Self-built Pavilion of the Participant (name of Participant)
______________ realised on the basis of the Communication of Free Building Activity Start Up
according to art. 6 clause 2, letter b) of the Decree of President of the Republic (D.P.R.) No 380/2001,
for the realisation of the temporary Participants’ Self-Built exhibition space at Expo 2015, favourable
approval of the Commission of Integrated Vigilance for Expo 2015 PG __________/_____________
dated ___/___/______
 Lot Cluster n. _________________of the Participant (name of Participant)______________
 Service Area n._________________
 Service Unit n._________________
 Cascina Triulza and surroundings (specify area/room)________________ floor _____________
 Thematic Area _________________
 Other area inside the Exhibition site _________________
 Palazzo Italia, floor ________
 Cardo artefact (specify) __________________ floor_____

OUTSIDE the Exhibition Site of Expo Milano 2015 and within the territory
4B1
of the Municipality of MILAN
-
In a PRIVATE AREA (located within the territory of the Municipality of Milan, outside the
Exhibition Site of Expo Milano 2015)
During the initiative called ______________________________________________________
__________________________________________________________________________
 which has been acknowledged as an “Expo in Città” event
 which has not been acknowledged as an “Expo in Città” event
which will take place in street _____________________________________________ n. _____
in rooms located:
 at street level
 at basement level where suitable conditions of ventilation, illumination and microclimate are
guaranteed (art. 65, c. 2 Legislative Decree No 81/2008) and for the use of which Local Health
authorities consent have given their consent (art. 65, c. 3 of Legislative Decree 81/2008)
 loft
 on the first floor or higher
Page 4 of 6

OUTSIDE the Exhibition Site of Expo Milano 2015 and within the territory
4B2
of the Municipality of Milan
-
In a PUBLIC AREA (located within the territory of the Municipality of Milan, outside the
Exhibition Site of Expo Milano 2015)
During the initiative called ______________________________________________________
_______________________________________________________________________________
 which has been acknowledged as an “Expo in Città” event
 which has not been acknowledged as an “Expo in Città” event
Which will take place _________________________________________________________
according to the request/authorisation for concession of public land registered at General Protocol. n.
dated ______________ for the carrying out of the initiative called___________________________
number of counters present (as in the attached list of operators)__________________________
NB: Section 4B2 does not apply to activities of street merchants activities on public areas subject to articles 16 and following of
Regional Law No 6/2010
5
NUMBER OF PERSONNEL
|__|__|__|__|
Indicate number of personnel expected at the moment of presentation of the SCIA, independently from the contract
type.
By “personnel” is meant whoever at any title working at the work site concerned by the present declaration.
6
DURATION of the ACTIVITY (Indication of the final date is valid as declaration of end of activity)
from _______/_________/______________ to ______/_________/_______________
Page 5 of 6
THE UNDERSIGNED FURTHERMORE
DECLARES

7
that the activity will be carried out in respect of all regulations applicable to the activity concerned by the
present declaration, in respect of the related prescriptions in the matter of urban regulations, public
hygiene, building hygiene, protection of the environment, health protection at the workplace, food safety,
and in respect of the local urban police regulations.

that the structures are ready as from the date of presentation of this Declaration.

that the relevant requirements, general and specific, regarding hygiene sub art. 4 and Attachment II of
Regulation (EC) n. 852/2004 of the European Parliament and Council dated 29 April 2004, have been met
coherently with the activity carried out;

that the personnel have been sufficiently trained on hygiene regulations and on procedures based on the
HACCP principles that are to be respected during the handling and serving of food.
DECLARES
His/Her OWN BUSINESS according to Community Regulation 852/2004
8
THE UNDSERSIGNED FURTHER
ATTACHES
copy of a valid identity document of the signatory (mandatory attachment)
 general floor plans where location inside Exhibition Site of Expo Milano 2015 can be identified (attachment to be
prepared by who fills out Section 4a)
 detailed floor plan on 1:100 scale showing functional configuration of the rooms – the internal subdivision of the
spaces as well as the floor level must be indicated (attachment prepared by who fills out Section 4a and 4b1)
 self-certification form concerning moral requirements as per art. 71 of Legislative decree 59/2010 with reference
to subjects indicated by Legislative Decree No 159/2011 (attachments to be prepared by who fills out Sections 4b1
- 4b2)
 list of participating operators/firms, together with related self-certification forms concerning moral requirements
as per art. 71 of Legislative Decree No 59/2010 referred to those subjects indicated by Legislative Decree No
159/2011 (attachments prepared by who fills out Section 4b1-4b2, when a sole organising subject presents a
cumulative SCIA)
 receipt of payment of health fees to ASL Milan (mandatory attachment, except for the sale of non food products).
9
SIGNATURE
_______,date ____________
signature___________________________________________
N.B. Copy of this declaration, together with its delivery receipt, must be clearly displayed to the public in the site
where the activity is carried out.
Page 6 of 6