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HomeMy WebLinkAboutApplication-CertsDetails lnternal Only License Restrictions/Conditions Seating: 1 30 Seats; 18 Barstools Expiration Date- 12t31t2026 Business lnformation Business Name* Sea Dog Brew Pub Business Mailing Address (if different) Business E-Mail. info@seadogcapecod.com Business Legal Entity Corporation Business Address in Yarmouth * 23 Whites Path Business Phone #- 508-694-6020 Business Type" Food Service Corporation Name (if applicable) Sea Dog Cape Cod LLC Tax lD (FEIN or SSNI* FEIN ls this a NAME CHANGE? No Owner / Manager !nformation Manager/Contact Person Name* Matthew Barry FEIN owneis Phone Number 508-728-1960 Manager / Contact Person Phone Number' 508-367-6894 PLEASE LIST STAFF MEMBERS WHO HOLD THE FOLLOWING CERTIFICATIONS AND ATTACH COPIES OF CERT!FICATIONS 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 owner's Name* Peter Lucido Name and Title Matthew Barry Telephone Number 508-367-6894 Address Email Location is Permanent Structure? Yes Emergency Telephone Number Please attach copies of certifications for al! listed below: List all Certified Food Protection Managers* Matthew Barry List all employees certified in Anti-Choket Matthew Barry List all employees wilh Allergen Certification- Matthew Barry Establishment Operations Length of Permit Annual I I I I I I Establishment Type Continental Breakfast Non-Profit Number of Seats lnside' 138 174 Mobile Common Victualler Wholesale Food Service Number of Seats 0utside * 36 Frozen Dessert Retail Service I I Residential Kitchen for Retail Sale Total Seats tr 0ther Name Change Only New construction, remodel or conversion requires an Occupancy Permit from the Building Department in order to receive a valid Food Permit. l, the undersigned, attest to lhe accuracy of the information provided in this application and laffirm that the food establishment operation will comply wilh 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 CilR 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 taxes required under law.* Submitted by Staff Matthew Barry Dec 27 , 2025 I Worker's Compensation lnsurance Affidavit Vending Food I tr tr Affidavit RestauranVBar/Eating Establishment I do hereby certify, under the pains and penalties of perjury, that the information provided above is true and correct.* Matthew Barry Dec 27 , 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 Hartford lnsurance Company Policy # or Self-ins Lic. # 76 WEG BV7PG1 Business lnsurer's Address 225 Kenneth Dr Ste 1'10 Rochester, NY 14623 Food / Retail Service Expiration Date 08t11t2026 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.* I 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 ESTABLISHMENI (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 that I have read and understand the Notice information above* THE HARTFORD THE HARTFORD BUSINESS SERVICE CENTER 3600 WISEMAN BLVD SAN ANTONIO TX 78251 September 5, 2025 For lnformational Purposes 23 WHITES PATH SOUTH YARI\,4OUTH M A 02664.1221 Account lnformation: Policy Holder Details : SEA DOG CAPE COD LLC DBA SEA DOG BREW PUB E Contact Us Need Help? Chat online or call us at (866)467-8730. We're here Monday - Friday Enclosed please find a Certificate Of lnsurance for the above referenced Policyholder. Please contact us if you have any questions or concems. Sincerely, Your Hartford Service Team WLTROO5 0910512025 THIS CERTIFICATE IS ISSUEO AS A MATTER OF INFORMATION ONLY ANO CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIR}IATIVELY OR NEGATIVELY ATIEND, EXTENO OR ALTER THE COVERAGE AFFORDEO BY TI4E POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BEYWEEN THE ISSUING INSURER(S}, AUTHORIZED REPRESEI{TATIVE OR PRODUCER, AND THE CERTIFIGATE HOLDER, IMPORTANT: lf lhe cortiricate hold€r is an AODITIONAL INSURED, the policy(ies) must be ondorsod. lf SUBROGATIONIS wAlvED, subject lo the terms and conditions of the poli6y, cortain policie3 may require an endorsement. A statem.nt on this certificato does nol confer rights to tho ceilficato holdor ln lleu ot 3uch endoEement(s). PRODUCER PAYCHEX INSURANCE AGENCY INC 76210755 225 KENNETH DR STE I1O ROCHESTER NY 14623 PHONE (AJC, No, EIl): \8OO1472-0472 (s85) 389-7894 /SURER{S) AFFOROTNG COVERAGE TNSURERA: Hartford Fire lnsurance Company 19682 rirSuREo SEA OOG CAPE COD LLC DBA SEA DOG BREW PUB 23 WHITES PATH SOUTH YARMOUTH MA 02664-1221 INSURER 8 o<-fu CERT!FICATE OF LIABILIry INSURANCE COVERAGES CERTIFICATE NUMBER REVISION NUMBER: @ 1988-2015 ACORD CORPORATION. All rights reservod' R THIS IS TO CERTIFY THAI THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUREO NAMEO ABO!€ FOR THE POLICY PERIOD INOICATED,NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFOROED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ATL THE TERMS, EXCLUSIONS ANO CONOITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED AY PAID CLA]MS. LIMTTSTYPE OF INSURANCE EACH OCCURRENCECOMMERCIAL GENERAL LIABILITY CLAIMS.MADE OCCUR MED EXP (Any oe r.,s) PERSONAL & ADV INJURY GENE RAL AG6REGATE PRODI]CTS, COMP/OP AGG GEN'L AGGREGA-TE LIMIT APPLIES PER LOC OTSER: JECT BOoILY INJURY (Per a@denl) AUTOMOBILE LIABILITY ALL OWNEO HIRED AUTOS SCHEDULEO NON-OWNED EACH OCCURRENCEUilaRELLA LIAB EXCESS LIAA OCCUR aercworu $ X E L EACI]ACCIDENT $1,000,000 E L DISEASE -ErA EMPLOYE€$1.000,000 $1,000,000E,L DISEASE. POLICY LIMTT oa/1 1t2025 08t11t2026 Ar{D ETPIOYERS'L|AAIIrY PROPRIEIOFYPARTNEFI/EXECUTIVE OFFICEF,'I{EMBER EXC!UDEO? TION DESCNPTION OF OpERAfIOIVS / tOC4rOrVS / l/E lCtES {ACORD l0l.lRem.rls Sch.dul., m.y b. ,tLch.d ll mom .pa@ l. rcqolnd) Those usualto the lnsured's Operations SI]OULD ANY OF THE AAOVE OESCRIBEO BEFORE THE EXPIRATIOTI DATE THEREOF, I{OTICE wlLL BE OELIVEREO IN ACCORDANCE WITH THE POLICY PROVISIONS. POLICIES BE CANCELLED d:.uun 3 /azd..,.z--: AUTHORIZEO REPRES€NTATIVE 23 WHITES PATH SOUTH YARMOUTH MA 026 .1221 For lnformational rposes acoRD 25 (2ol6103)The ACORD name and logo are registeted marks oI ACORD INSUR€R E: 76 WEG BV7PG1 laooLlsuBRI poucyNu BER PoLrcY EFF I POLTCY EXP IINSR IIYVD I TMMIDO/YYYYI llMf/DD,"lYYYl I sootrv ruunv leer pem; I I T_lg" NF ServSafe SerYSqfe" CERTIFICATION MATTHEW BARRY ftr 3J@nr[rly co.nplcting rh6 d,ondor,& id fudfi for ttE son st' Food hobdirr ,vrcrroger certiffcotr'on Exominotion,whicrt i! occredibd by *e ANSI (Americon florbnol SundonJs hfturs1 ttorirrola."rjirori-, g""rd (ANABF"- '' ConErsnce for Food Proreaion (CFP|. 7t512024 DATE OF EX Locol lolls opply 5664 EXAM FORM NUMBER 7t512029 DATE OT EXPIRATION frr recertiff cotion rrquir.nEnh. ffi f1911{$!tj.,u{^fidnicdrltodrGbn ra.qi:rio.&r,rdE. rr( F.ln6,rtqrorriEr F i.inot tr wd.06 aI #0655 coi'lod 6 eii' rriidr or 23t s. Wod, Dttu, S.jL 3aO, dicqgo, I. .o6oa63si * S.!6*OldrE ,r. TC('tDII!O PNOGIAM rLh your locol rsg c IIFICATE N \yLe{v CT TTFICAIE OF ATTTRGEN AM.RENE S S TNruN ING Name of ReciPient MATTEw BARRY Certifi cate Nurnber' 6050410 Date of Completiot 1112r2on Date of Expiration' 't2t12t&27 kudBp Tbe ahNe-named F6on is krcly ksuul tbis certifuate for ompleting at allergcn swarencrt fi*ining Fogrum niotoizri ty tt , M^.rhoutts Dcpttmmr of Publk Hcakh" io *tirdorr, *itb 105 CMR 590.009(G)(3)(a). csl o Mers*lnrecttr Rcrteurrot &ao&tioa 33 Tirnpitc Rdd,Suitc 102 Soutlrbotang\ MA 01772 508-303-9905 w*w'mrEatdrrotraaoc.or8 8m'765.2122 *Ew.rtltaurant.org liis ccrtiftatc zoill be vatidfnfu (5) yearsfrom daa ofcompletion' ffi Thi9 card certifies thai the individual has succos3fullycompletod the requlrBmonts in accordance wlth th€Nationa! Hsalth & Safety Association cunlcutum. Course administered by the National Health &Safety Association follo,rring the 2020 ECC/ILCOR and American Hearl Association guidelines. cERflFtED ON Dec ,t3, 2022 VALID 2 YEARS lD423300_320153'141 sruDENr Matthew Barry For couFe detatls and receftmcatm, visii cpr.ao You'll find your card above. lt includes the date of certification, a unique id, and the tiue of the course you took with National Heafth & Safety Association. Print your card, cut it out, and then fold it down the center. You can then tape or glue it together. Carry the card in your wallet or purse, to have avairabre if you need to reference it. We have also sent an email with a link to your wallet card. Make sure to save the email so you can print additional copies of your card at any time. Congratulations, National Health & Safety Association JL National Health &'ll- Safety Association Standard CPR/AED (adult, chitd, infant)