PREAUTHORIZATION OF PURCHASE REQUEST

Prior to requesting a preauthorization of purchase request, your facility must be enrolled in the Rancho Mirage Edible Food Program and possess a valid Rancho Mirage Business License.

Items eligible for consideration of reimbursement include sustainable alternatives such as compostable, fiber-based, or reusable to-go containers, to-go utensils, one-time use straws, and innovative to-go one-time use edible utensils like spoons for ice cream. Each pre-authorization request should amount to a minimum of $500, and each location may submit up to 5 requests within the program. Upon pre-authorization, participants may purchase the items and then submit proof of payment for reimbursement and must submit the Reimbursement Form within 45 calendar days of purchase.

Facility Name(Required)

Facility Address(Required)

Enrolled in the Rancho Mirage Edible Food Program

Valid Rancho Mirage Business License

Link(s) to item(s)

Or upload/attach of item(s)

Accepted file types: jpg, gif, png, pdf, Max. file size: 100 MB.

By signing this preauthorization request, I declare under penalty of perjury under the laws of the State of California that the facility has satisfied the eligibility requirements, that I understand submitting a preauthorization request in no way guarantees reimbursement of any sort, and that the forgoing is true and correct, that I have full authority to act on behalf of the above named facility, and agree to indemnify, defend, and hold City harmless from any claims and/or liability related in any way to participation in the program.

Signature(Required)

Date(Required)