The URL can be used to link to this page

Home My WebLink AboutApplication-CertsDetails lnternal Only License Restrictions/Conditions Seating: '18 Expiration Date* 12t31t2026 Business lnformation Business Name* Burger Queen Business Mailing Address (if different) Business E-Mail* bqyarmouth@gmail.com Business Legal Entity Corporation Business Address in Yarmouth * 1297 Route 28 Business Phone #* 508-258-0708 Business Type* Food Service Corporation Name (if applicable) Tax lD (FEIN or SSN)* FEIN ls this a NAME CHANGE? No Owner / Manager lnformation owner's Name' Geanina Edwards Manager/Contact Person Name* Anthony Edwards Name and Title Heather Edwards PLEASE LIST STAFF MEMBERS WHO HOLD THE FOLLOWING CERTIFICATIONS AND ATTACH COPIES OF CERTIFICATIONS Name of Certified Food Protection Manage(S) All food service establishments are required to have at least one (1) PERSON lN CHARGE on site during hours of operation FEIN *-*-21',t7 owner's Phone Number 5082469918 Manager / Contact Person Phone Number' 5086854927 Address 1297 Route 28, South Yarmouth MA 02664 Emergency Telephone Number 5086854927 Please attach copies of certifications for all listed below: List all Certified Food Proteclion Managers* Heather Edwards List all employees with Allergen Certification- Anthony Edwards Establishment Operations Length of Permit Annual Telephone Number 5082580708 Establishment Type Continental Breakfast Email bqyarmouth@gmail.com Location is Permanent Structure? Yes Common Victualler Itr I I I I Non.Profit Residential Kitchen for Retail Sale Number of Seats lnsidet 18 Tolal Seats '18 Mobile Vending Food I Wholesale Food Service Number of Seats Outside * I Frozen Dessert Retail Service Other II I 0 I Name Change Only Affidavit New construction, remodel or conversion requires an Occupancy Permit from the Building Depaftment in order to receive a valid Food Permit. l, the undersigned, attest to the accuracy of the information provided in this application and laffirm 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 .l05 CMR 590.000 and the Federal Food Code. Pursuant to MGL Ch. 62C, Sec. 49A, I certify under the penalties of periury that l, to the bcst of my knowledge and belief, have filed all state tax returns and paid taxes required under law." Heather Edwards Dec 31 , 2025 Worker's Compensation lnsurance Affidavit Type of Business* I am an employer with employees * Submitted by Staff I Business RestauranVBar/Eating Establishment I do hereby certify, under lhe pains and penalties of per,ury, that the information provided above is true and correct.* Heather Edwards Dec 31 , 2025 lnsurance Policy lnformation Failure to secure coverage as required under Sectlon 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. lnsurance Company Name The Hartford Policy # or Self-ins Lic. # 08 SBA BN6RG6 lnsurer's Address 3600 WISEMAN BLVD SAN ANTONIO TX78251 Expiration Date 0211812026 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 COMMENCEMENT. RENOVATIONS MAY REQUIRE MA ENGINEER SITE PLAN. I acknowledge thal I have read and understand the Notice information above* I ServSafe Natlonal Restaurant Association Serrrsqfe' CERTIFICATION HEATHER EDWARDS G br successfully completing the stondords set forth br the ServSqEo Food Prolection Monoger Certilicolion Exominotion, which is occredited by the Americon Notionol Stondords lnstiue IANSI)-Conbrence for Food Prote.tion (CFP). ER 10776 EXAM FORM NUMBER 3t3t2027 DATE OF EX DATE OI EXPIRATION for recertilicotion rcquirements.Locol lows opply. Ch iotion Solutions s EitltbEffi ,..:'Iv, acciE0tTtD PR063A$&Eiti. lll@l St nfr& tlllitub,d f,CoL,cEh.tu Pol6n6 #0655 s.*soL hgo m tndoffik o, fi. NnAEF. Nolioid R6iqurcnt &Eiolion@ ond *E oE d€igi G.rr.Gr d *i$ +6li(s or 233 S. wod. Dir, S!ir. 3!00, Cfii€go, lL 6&:|83 6 Swsoleh!@ot.dB 3t312022 1-o t, 2 F MINATION k wth your locol rEgulolDry (rg t igh National Restaurant Association ServSofe Allerq Certificote of Cori TMens pletion "#"" Aworded to ANTHONY EDWARDS Provided by the Notionol Restouront fusociotion cerriticorc N,,^8", 7 66447 2 D"t" 212312025 Exoirotion Dore 212312028 shermon srown Exocutive Vice Presidenl, Business Ssrvices AlSl Natohal Aec ledtta on Soad ACCREDITEO -_-@@_ CERTIFICATE ISSUER #0655 ffi ServSafe Wesco lnsuranca Company A Sbck lnsurance Company WORKERS COI\,4PENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY wc990001 B 1of 5 INFORMATION PAGE Ncci Code: 26135 Insured: Burger Queen LLC 1297 Route 28 South Yarmouth, MA 02664 Other workplaces not shown above: None Producer: AP lntego Insurance Group, LLC - NY PO Box 31250 Salt Lake City, UT 84131 PolicvNumber: WWC3836764 _lndividual _Corpomtion or Federal Tax ID: Risk Id: Renewal of: _Partnership X LLC 9934221t7 wwc3771443 2. The policy period is from 212512026 to 2/25/2027 l2:01 a.m. at the insured's mailing address. The premium for this policy will be determined by our Manuals ofRules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. See Extension oflnformation Page TOTAL ESTIMATED ANNUAL PREMIUM STATE ASSESSMENT TOTAL ESTIMATED COST Minimum Premium lssue Date: l2l3l/2025 Countersigned by Authorized Representative 861 25 886 292 3- A. Workers Compensation Insurance: Part One ofthe policy applies to the workers Compensation Law of the states listed here: Massachusetts B. Employers Liability lnsurance: Part Two of the policy applies to work in each state listed in item 3.A. The limits ofour liability under Part Two are: State Bodily Injury by Accident Bodily lnjury by Disease Bodily Injury by Disease $1,000,000 each accident $1,000,000 policy limit S1,000,000 each employee C. Other States lnsurance: Part Thee ofthe policy applies to the states, ifany, listed her€: All states except ND, OH, WA, WY and State(s) Designated in ltem 3.A D. This policy includes these endorsements and schedules: See Extension of Information Page 1.