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Home My WebLink AboutLicense-App-CertsDocusign Envelope lDr D89FA390-0C1A4EF1-82B0-939474392E21 A **MUST BE POSTED ON PREHISESI*This License affirms that the specifled premises, structure, or portion thereof has m€t the necessaryconditionr including any inspections required at th€ time of issuance.It must be framed or lamlnated and prominently displayed in a clearly visible location within the approvedpremises. The Commonwealth of Massachusetts Town of Yarmouth Health Department FOOD ESTABLISHMENT TICENSE UED TO: 1175 rt 28, South Yarmouth , MA 02664 Cape Cod Collaborative 1 1TheUose o C5 RM S to estab S mh n m muprp tas dn rdaS rfo rh so rse alo s er)a ed n ht epsIbsunSeosfrenanSSrocet1r0dnstUbtnppspofofodsrIaenaMchssaIseUtts0C5Rt40500s00hbraenaebcostedrunadadetomroeothetnuppedrlnruISoefroptectn th eIpops ub c eha th License Expiration: December 3,., 2(J26 Board of H..!th: Hlllard Boskey, M.D., Chairman Mary Craig, Vice Chairman Charles I Holway, Clerk Laurance Venezia, DVM Eric Weston Fee: $3O.OO Restrlctlons / Condltlons: Interim Health Director lames Gardiner Signature of Interim Health Director 6orll^ty Certificate No. BOHF-25-202 of 500.000 Details !nternal Only License Restrictions/Conditions Expiration Date' 12t31t2026 Business lnformation Business Name* Cape Cod Collaborative Business Mailing Address (if different) Business E-Mail. j.andrews@capecodcollaborative.org Business Legal Entity Other Legal Entity Business Address in Yarmouth * 11751128, South Yarmouth, MA02664 Business Phone #* 508420-6950 ext 11 56 Business Type. Food Service Other Legal Entity Corporation Name (if applicable) Tax lD (FEIN or SSN)- FEIN ls this a NAME CHANGE? No Owner / Manager lnformation Owner's Name* Cape Cod Collaborative Manager/Contact Person Name* Jamie Andrews Name and Title Germaine Leonard Culinary teacher Telephone Number 508-420-6950 FEIN **_***6040 owner's Phone Number 508420-6950 Manager / Contact Person Phone Number' 508-816-5551 Address Email PLEASE LIST STAFF MEMBERS WHO HOLD THE FOLLOWING CERTIFICATIONS AND ATTACH COPIES OF CERTIFICATIONS Name of Certified Food Protection Manage(S) g.leonard@capecodcol laborative.org All food service establishments are required to have at least one (1) PERSON lN CHARGE on site during hours of operation Emergency Telephone Number Please attach copies of certifications for all listed below: List all Certified Food Protection Managers* Germaine Leonard Lisl all employees certified in Anti-Choke' Germaine Leonard List all employees with Allergen Certification- Germaine Leonard Establishment Operations Lenglh of Permit Annual Establishment Type Continental Breakfast Location is Permanent Structure? Yes Common Victualler II I I I Non-Profit Residential Kitchen for Retail Sale Number of Seats lnside* 50 Frozen Dessert Retail Service 0lher Wholesale Food Service Total Seats 50 Mobile Vending Food I Name Change Only I II I I tr Affidavit 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 the accuracy of the information provided in this application and I affirm 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 taxes required under law.* Submitted by Staff James Andrews Dec 19, 2025 Worker's Compensation lnsurance Affidavit I Type of Business- I am an employer with employees * Business Other Other Business School I do hereby certify, under the pains and penalties of perjury, that the information provided above is true and correct.* James Andrews Dec 19, 2025 lnsurance Policy !nformation lnsurance Company Name MEGA Policy # or SelI-ins Lic. # wcx3405240025 lnsurer's Address 55 Walkers Brook Drive, Suite 402, Reading, MA 01867 Expiration Date 07t0112026 Food / Retail Service 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. 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 RENOVATTONS TO ANy FOOD ESTABLTSHMENT (pAtNTtNG, NEW EQUtpMENT, ETC.) MUST BE REPORTED TO AND APPROVED BY THE BOARD OF HEALTH PRIOR TO COMMENCEMENT. RENOVATIONS MAY REQUIRE MA ENGINEER SITE PLAN. lacknowledge thal lhave read and understand the Notice information above* o.#CERTIFICATE OF LIABILITY INSURANCE 7/8/2025 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRi'ATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIESBELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTTTUTE A CONTRACT BETWEEN THE |SSU|NG TNSURER(S), AUTHORTZEOREPRESENTATIVE OR PRODUCER, AND THE CERNFICATE HOLDER. IMPORTANT: lf the ce.tificate holder ls an ADDITIO lf SUBROGATION lS WAIVED, subiect to the lerms NAL INSURED, the policy(ies) must have ADDITIONAL INSt RED provisions or be endorsed, and conditions of the policy, cerlain policies may require an endorsement. A statement onthis certiticate does not confer hts to the certificate holder in lieu of such endorsem s PROOUCER cclts, c/o Canhon Cochran Managefient Seryices, lnc. 55 Walkers Brook Drtve Suite 402 Reading, MA 01E67 INSURED CAPE COD COLLABORATIVE 41E BUMPS RIVER ROAD OSTERVILLE, MA 02655 COVERAGES CERTIFICATE NUMBER REVISION NUMBER CIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAI\,IED ABOVE FOR THE POLICY PERIODINDICATED. NOTWITHSTANDING ANY REQUIREI'ENT, TERI\,4 OR CONOITION OF ANY CONTRACT OR OTHER DOCUIVENT WITH RESPECT TO WHICH THISCERTIFICATE I\,4AY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLL.]SIONS ANO CONOITIONS OF SUCI.] POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCEO BY PAID CLAIMS. THIS IS TO CERTIFY THAT THE POLI AOOL SUBR POLICY NUI'BERTYPE OF INSI'RANCE F- F"*' fl$ S. COMP/OP AGG GEN ITY 0cMS-MAD GEN'L AGGREGATE LIMIT APPLIES PER[ '*,.' f] !f.g ! .o./ I orr.^ I PERSONAI T ADV INJURY I oa*a*a oon"aaora TO RENTE- S (Ea occur6.@) OWNED AUTOS ONLY HIRED I COMBINEO SINGLE I IMITLtE4accd€ltl I eoorrv rr.r.runv 1e", p"*y LqqolLY INJURY (Per accdenr) PROPERryDAITAGEE! S AUTOMOBILE LIAEILITY SCHEDIJLEO AUTOS NON.OWNED , CLAII\'S.MADE S Sl SRETENTION $ !49! qcqu!8ElgE AGGREGAIE WORKERS COIIIPE'iISATION AIIO EMPTOYERS' LIABILIfY ANYPROPRIETOR/PARTNER,/EXECTJTIVE OFFICEF/MEMAER EXCLUDED?E.L E"ACH ACCIDENT E,T, OISEASE. EA EMPLOYEEE.-"****.r.-t 1,000,000 1,000,000 t,ooo,ooo STATUTE wcx3105240025 x A 7/1/2025 7/1/2026 3 T_ OTH. OESCRIPTION OF OPERA IIONS / IOCATIOIiS / VEHTCLES (ACORD iol, Addtton.t Remart. Sch.dul., m.y be .tr.ch.d at mor. .p.6 t. Equrr.d)OESCRIPTION Of OPERA CERTIFICATE HOLDER CANCELLATION ON. All righls reserved. CenReclD:731062 SHOULD ANY OF THE AAOVE DESCRIBED POLICIES BE CANCELLED BEFORE11!-llfllfloN DArE THEREoF, NorcE wLL ee oeirvEiEit iNACCORDANCE WTH THE POLICY PROVISIONS. CAPE COD COLLABORATIVE 118 BUMPS RIVER ROAD OSTERVILLE, MA 02655 e\--r- .D.--*-_'rz_ AUIH ORIZED R EP RES ENTAIIVE o 1988.2015 ACORD CORPOThe ACORD name and logo are registered inarks of ACORD RATI PRID:347457733 Darla Duckwit2 l# N"\. (21+aaa-666s?Ni". .,1\. (217)tu-1 1 s6 IIEGA PROPERTy & CASUALf'/ GROUP INC. INSI]RER E .LActi occunaerce ]r I 5 S I ACORD 25 (2016/03) il ServSrrfe" CERTIFICATION GERMAINE LEONARD & st,cctstulty oi/e ng ttre rtoJorJs o bah lor tle SewSo[eo tood *otea;cr Uonoge. C.di{icolion Esmirclion*li.[ i! o.o€Jiied by,le Arn6i6n Notionol sbndo.d3 lnstil',i. IANslFCdE *e fo. F6d Prc{e<li6 {CfP). 23922219 CERTIf ICAT E NUMS ER 10796 EXAM FORM NUMBER ilffilDr'*"#ilLtxPRAroN #0a55 Erkurivd Vi.e P.esidenr, Noiiorol Rerouroor A$oc io rion Solurions ffi,@rdc!@ eri,/& n r!5d, C.llltb 266, ..nJdni rr, N oo€_x,, o!soro,* 3 a SbJc! A3 2t @is,Jt&'ds.4e6rdE s..5.i roe. orarEri o; fr.Nr;;-;' jfilff ,,,,, €e'..@td6'Nt^t+**ii:6"-aa.**'ft;nrEe ccid tr *$ qdis .i 233 ! wo{, tri., iJa. tae, Oi@ro, r 6oao&{!3 , S-a.tl,eed.a!. a ServSafe 2 t@wl !:l'ualsndr.e 1 I ServSafe ServSqfe Allerq Certificote of Cofi TMens pletion "t"" Aworded to GERTVIAINE LEONARD Provided by the Notionol Reshuront Associotion Cerfificore 1r1r-5.. 757934't 1t19t2025 Exoirorion Dore 111912028 Altsl National Aecteditation Roatd ACCREOITED -------@- CERTIFICATE ISSUER f0655 Execurive Vice Presidenl, Businer Services ffi National Restaurant Association EgirrrEd rred.ro,k u$d u.dq lk6e by Sotu oro o.d no, d b. orh.tuis uod wi bur rh..xplicir writLn p.,nkrion o, rh. @., olech mod