The URL can be used to link to this page

Home My WebLink AboutApp-License-CertsDocusign Envelope lD: 7 D 5 ABE34 -7 AB7 47 27 -885A-9049DAEF8699 {.*}IUST BE POSTED ON PREMISES'}* This License affirms thtt the specifled premises, structure, or portion thereof has met the necessaryconditlons including any inspectlons required at the time of lssuance.It must be framed or laminated and prominently displayed in a clearly visible location within the approvedpremises. Interim Health Director .lames Gardiner Signature of Interim Health Dlrector ail";*i; A.The Commonwealth of Massachusetts Town of Yarmouth Health Depaftment FOOD ESTA3LISHMENT LICENSE Old King's Coffeehouse 44 Route 28 ISSUED TO:Certificate No. BOHF-25-201 e purpose of 105 CMR 500.000 is to establish minimum standards for those persons engaged in the business of preparing, processing, or distributing food for sale in Massachusetts. 105 CMR 500.000 shall be liberally construed and applied to promote the underlying purpose of protecting the ublic health. Th License Expiration: December 3L, 2026 Borrd of l{o!lth: Hillard Boskey, M.D., Chairman Mary Craig, Vice Chairman Charles T. Holway, Clerk Laura nce Venezia, DVM Eric Weston Fee: $185.OO Restrictions I Condltions: Seatlng: 42 Details lnternal Only License Restrictions/Conditions Seating: 42 Expiration Date. 1213',12026 Business lnformation Business Name* Old King's Coffeehouse Business Mailing Address (if different) Business E.Mail* lnfo@oldkingscoffee.com Business Address in Yarmouth * 44 Route 28 Business Phone #. 7744705808 Business Type* Food Service Business Legal Entity Corporation Name (if applicable) ls this a NAME CHANGE? No Owner / Manager lnformation Owner's Name' Kate Corliss Manager/Contacl Person Name' Kate Corliss Name and Title Tara Sanders, General Manager PLEASE LIST STAFF MEMBERS WHO HOLD THE FOLLOWING CERTIFICATIONS AND ATTACH COPIES OF CERTIFICATIONS Name of Certified Food Protection Manage(S) Alt food service establishments are required to have at least one (1) PERSON lN CHARGE on site during hours of operation FEIN *-*"3255 Owner's Phone Number 5083670058 Address Tax lD (FEIN or SSN)* FEIN Manager i Contact Person Phone Number" 5083670058 Telephone Number +1 (508) 280-9924 Emergency Telephone Number Please attach copies of certifications for all listed below: List all Certified Food Protection Managers* Tara Sanders, Ceara Price, Kirsten Daughinais List all employees certified in Anti.Choke" Tara Sanders, Ceara Price, Kirsten Daughinais List all employees with Allergen Certification. Tara Sanders, Ceara Price, Kirsten Daughinais Establishment Operations Length of Permit Annual Email Tara@old ki n gscoffee.com Location is Permanent Structure? Yes Establishment Type I I I r I I Continental Breakfast Non-Profit Residential Kitchen for Retail Sale Number of Seats lnside* 42 Total Seats 5B Mobile Common Victualler Wholesale Food Service Number of Seats 0utside ' 16 Frozen Dessert Retail Service I II Vending Food Other Name Change Only I Affidavit New construction, remodel or conversion requires an Occupancy Permit from the Building Department in order to receive a valid Food Permit. I l, the undersigned, attest to lhe accuracy of the information provided in this application and I atfirm that the food establishment operation will comply with 105 CMR 590.000 and all other applicable law. I have been instructed by the Board of Health on how to obtain copies of 105 CMR 590.000 and the Federal Food Code. Pursuant to MGL Ch. 62C, Sec. 49A, I certify under the penalties of perjury that l, to the best of my knowledge and belief, have filed all state tax returns and paid tares required under law.' Kate Corliss Dec 18, 2025 Submitted by Staff I Worker's Compensation lnsurance Affidavit t-l I do hereby certify, under the pains and penalties of per,ury, that the information provided above is true and corect.i Kate Corliss Dec 18, 2025 lnsurance Policy lnformation Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of uP to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of lnvestigations of the DIA for insurance coverage verification. Type of Business- I am an employer with employees * lnsurance Company Name Continental Casualty ComPany Policy# or Self-ins Lic. # wc625207552 Business RestauranVBar/Eating Establishment lnsurer's Address 151 N. Franklin St Chicago, lL 60606 Expiration Date 0610112026 Food / Retail Service SEASONAL FOOD SERVICE OPENING:All food service establishments must be inspected by the Health Department prior to opening. Please contact the Health Department to schedule the inspection three (3) days prior to opening. CATERING POLICY: Anyone who caters within the Town of Yarmouth must notify the Yarmouth Health Department by filing the required Temporary Food Service Application form seventy-two (72) hours prior to the catered event. These forms can be obtained at the Health Department, or from the Town's website at www.yarmouth.ma.us under Health Department, Downloadable Forms. FROZEN DESSERTS: Frozen desserts must be tested by a State certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Department. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms have been met. OUTSIDE CAFES: Outside cafes (i.e., outdoor seating with server service), must have prior approval from the Board of Health. OUTDOOR COOKING: Outdoor cooking, preparation, or display of any food product by a retail or food service establishment is prohibited. I acknowledge that I have read and understand the information above.* Notice PERMITS RUN ANNUALLY FROM JANUARY 1 TO DECEMBER 31. IT IS YOUR RESPONSIBILITY TO COMPLETE THIS APPLICATION EACH YEAR. ALL RENOVATIONS TO ANY FOOD ESTABLISHMENT (PAINTING, NEW EQUIPMENT, ETC.) MUST BE REPoRTED To AND APPROVED BY THE BOARD OF HEALTH PRIOR TO COI\iIMENCEMENT. RENOVATIONS MAY REQUIRE MA ENGINEER SITE PLAN. lacknowledge that I have read and understand the Notice information above* tr Tara Sanders ft r*(6stult {sPr.t€ ln. rbnd.rdt $t loih ro, lh. Food Protectlon Manager *ikh B &...{td b, rh. &Eft.^ Nrtryr.r $aodids lnntule ( N50 ' (onr...ft. lor lo.d P'otc'ld (cFP) CERTIFIGATE --G)'-:,fu^h,,'d'.kG!!o,, tn lr!r.Fr..dt '.(o.9.tYl'q rrdE r cr(l tL tfrr. tt10, Alrisvs' Sole @6;t m E/ARNasERvE CERTIFICATE OF COMPLETION This certifies tha! Tata sandeF is awa.ded lhis certilicat€ lor Leamzserve Food Allergy Training Course ^#^".tst Nrno^.l A..t.dt,ron 8o.td-3",ffi- ' r::ri !':'i srrr\ r(r'r.iri..r! ACCREOITEO =_-@@- cEFnFtcatt tss\Eilolr5 r OF COMPLETION Tara Sanders The student has su.cerstully met th€ r€qui.emenG lor.€rtification by completing the cognitlve tr.ining.nd skllls evaluation 16 th€ sp€.ified.ooEe tn tem5 of NCPRFG .nd In.ccordance with the €orespof,d 69 ILCOR, OSHA, and AHAO/ECC guidelines (2020,. O.t:Dea8.2025 R.n.u:O.< 8. ?027 llrr:FE98AD7 lnrtructo..: pad I. S(ruton Cour!. Prlvld.d Byl NationalCPRFoundaUon" IN RECOGNITION OF SUCCESSFUL COMPLETION IN B.sic Ufe Suppon - BLS HCP - CPR (Adult / Child / lntant / Choking) Automated External Defibrillation / Fi6t-Aid "*,-*,g(,[J^-L tI C'JA OLD KINGS a(rFi La.I(' 44 ROUTE 28 WEST YARMOUTH, MA 02673.8106 Coverage Provlded BY Continentf,l Casuallv Comoarry a Slock lnsurance k ( T Typr -of Entity: Limited Liability CompanyFC unbcr: g3-3843255 lnt ltrat tD IIo.: OO1 l433tO ll th!.s lra othor l{am€d lnruradg It thl! lra ottr, work placos not Se6 Name and Address Schedule aftached. shown €bovo: See Name and Address Schedule attached 06/01/2025 to 06/0 1t2O26 at 12:O1 a.m tandard Time at the Namad lnsureol,s mailing address shc ^ niAnnivcEary Rating Date: NONE I [ocrt-!!1!r acootrr nt by Di!sasc Bodt @bv ol..r." !_Qgooor ---=.--8ila.,d $1,000{9o1$!.ccident 91 ,000,000 I Folicy 1;61i1st,ooo,OOO-1o"il;r"; ww.,#_",^c.rrhy gqrtlrry, t!,| N Fr.nhth st, chlcrto, tL 60006 PoI Policy Effa w.c e zszctivo Oate 07552 lrern 3 B. Employers Liability lnsuranceItem 3.A. Th Part Two oe limits of oul t this poliabiliry uod licy 3pp1;"et Part Two s to work inate 13 N!tlor.Councll oo atloh lh! Policy Paea:8ot17 oato1tzc WORKERS COMPENSAflO AI{D EMPTOYEBS TIAB'LITY POI'CY IIUFORMATION PAGE NCCI Carrier Coder 10243 ll lrem I NEm6d lnBurad and Malllng Addross r Pollcy ltlumber Pollcy ,tlumbor: WC 6 25207552 Rsnawel ol: WC 6 25207552 THE HILB GBOUP OF NEW ENGLAND LLC 973 IYANNOUGH RD HYANNIS, MA 0260i.1 869 Producer Processing Code: 1 2O-O4547 2 h€m 2 poticy pariod ]Srr!at: MA--__- 8ot state listadEEETI rkers Co nsurancela this policy appliosher Ett IT Part ofOneolthestateslisred tofe the ''lc, ar ar.chr Be--;;i_