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License Restrictions/Conditions
Seating: 99
Expiration Date*
1213112026
Business lnformation
Business Name*
DC Porrecllis Pizzeria
Business Mailing Address (if different)
Business E-Mail*
dcporcellispizzeria@gmail.com
Business Legal Entity
lndividual
Business Address in Yarmouth *
731 Route 28, South Yarmouth, MA02664
Business Phone #*
508-694-5965
Business Type'
Food Service
Corporation Name (if applicable)
Tax lD (FEIN or SSN)-
FEIN
ls this a NAltlE CHANGE?
No
Owner / Manager lnformation
Owner's Name*
Eleanor Keleher/Candace Cook
Manager/Contact Person Name"
Eleanor Keleher
Name and Title
Eleanor Keleher
PLEASE LIST STAFF MEMBERS WHO HOLD THE FOLLOWING CERTIFICATIONS AND ATTACH
COPTES 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
..-*-480'1
Owner's Phone Number
630405-8526
Manager / Contact Person Phone Numbef
630405-8526
Address
731 Route 28
Emergency Telephone Number
630-405-8526
Please attach copies of certifications for all listed below:
List all Certified Food Protection Managers*
Eleanor Keleher
List all employees certified in Anti-Choke-
Eleanor Keleher
List all employees with Allergen Certirication*
Eleanor Keleher
Establishment Operations
Length of Permit
Annual
Email
dcporcellispizzeria@gmail.com
Location is Permanent Structure?
Yes
Telephone Number
630-405-8526
Establishment Type
I
I
r
I
I
I
Continental Breakfast
Non-Profit
Residential Kitchen for Retail Sale
Number of Seats lnside*
99
Total Seats
Common Victualler
Wholesale
Food Service
Number of Seats Outside .
0
Frozen Dessert
Vending Food
I99
II
Retail Service
I
Other Name Change 0nlyr
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 informalion
provided in this application and I affirm that the food
establishment operation will comply with 105 CMR 590.000 and
all other applicable law. lhave been inskucted 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 cerlify
under the penallies of perjury that l, to the best of my
knowledge and belief, have filed all state tax returns and paid
taxes required under law,*
Eleanor
Keleher
Jan 13,
2026
Worker's Compensation lnsurance Affidavit
Type of Business-
I am an employer with employees *
Submitted by Staff
I
Business
I do hereby certify, under the pains and penalties of periury, that
the information provided above is true and correct.*
Eleanor
Keleher
Jan 13,
2026
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 andlor 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
AIM mutual
Policy # or Self.ins Lic. #
AWC-400-704 1 052-20254
lnsurer's Address
po box 4070 Burlington ma 01803
Expiration 0ale
05t04t2026
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.
lacknowledge that lhave 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 TOAND APPROVED BY THE BOARD OF HEALTH PRIOR TO COMMENCETMENT.
RENOVATIONS MAY REQUIRE MA ENGINEER SITE PLAN.
lacknowledge that lhave read and understand the Notice
informalion above'
I
s0 \TRAINING -
LEARN2SERVE TT'OD PNOTEGTION MANAGER CERTIFICtrIION
This certifies that
Eleanor Keleher
has achieved the title of
Certified Food Protection Manager
lssue Date: Osll7l2UB
Certif icate nunrber: LBC-3-031I76
Test Name: Exa:n ForE A28 @W
I
Samaritha l'lontalbano,operating Officer
TI.'I-\ CFRfIHCATE TS AJON.TRANSF€RAiLE & VALI' UP|A 5 YEAPS FFO'I fHE ISSLIE DAIE
OEPEN&N6 AN YOUR LOCAL HEALTit A€FAR'TNEIT| S FEOUIPEI'IET!fS.
5000 Plaza on the Lake, Suite 305 I Austin, TX ?8746 I 82.881.2?J5 I www.trE8tratolng.com
>8 rmE)>t -$qEs_
congratulations on becoming a certified Food protection Manager.
Learn2Serve also provides training courses in:
Food Safety Handler, Alcohol Seller/Server, HACCp, and Sexual Harassment
Please contact us today to learn more about how you can take advantage
of these quality courses, or visit www.Learn2Serve.com.
h6s Edri€rrEd ti6 r hd
Certified Food kotectiou lrann €t
tsarlk lE/tza3ffita drr$er: L2sc-3-@i776
T.at lErE: Etm ForroA28 __.az@-trrrueo.Cr€t-qarb
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ElPanar Keleher
Tlrb c€rtttu tlEt
#0975
ServSafe
National Restaurant Association
SerYSqfe'
CERTIFICATION
KOSTADIN MIRCHEV
for successlully completing the sicndords set forth for the ServSobo Food Prp,teclion Monoger Certificotion Exominotion,
which is occredited by the Americon Notionol Stondords ln$rde {ANSlFGonhrence lor Food Protection {CFP).
ER
s608
EXAM FORM NUMBER
512512028
DATE OF EX DATE OF EXPIRATION
lor recedificolion requiremenls.Locol lows opply
iolion Solulions
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CorEtu*irfiqeti@ot233S.Wo*rDrn,Suih3am,cllicogp,tL60606.6383dS.,SoLOBLu.o.r.o,!.
5125t2023
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m LEENX EgERvE"
TRAIN I N G'
CERTIFICATE OF COMPIJTION
Thls certifies that
Eleanor Keleher
ls awardod thls certlflcsts for
Leam2Serve Food Allergy Training Course
o HoUrs
2.00 .g lornpletlon 0atE
0anu2c2s
i [9.! trpkotlon oatet l:j 0,,nulg26
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ANEI.FA.002610
AllE llrtlomt Aaata. ta on Eoed
ACCFTEDITED
0tflclrl CENNFICATE ISSUER
rHls cERlFlcrrE Is NoN-TRtNsF€ffaBLE 'oela
For €mployer v6riflc6tlon ot certllicste yrlldlty, pl6.!e 6end your I equalt to Food HEndla rProqramAdmln@360trrin lnq.aom
5000 Pl..a on rhe L.ke.SlJlte&)6 i Au8tln, TX 78748 I 87.881.2255 I www Se0tralntng.com
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TAP SENIES. LLC
Ano{t4ttnte, @, l, dcAinilenwnd,
T Ais, i.s ho.Aq *tti{ird. tAat t*o5n5/2023
Eleanor Keleher
Aaung succastttullty ronploled
l.fre coat*e al slud4
Approved llenual Chol(e Saving Proceduffi Tralnim
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Please print your
card on sturdy
cardstock.
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A,CORif
COVERAGES
CERTIFICATE OF LIABILITY INSURANCE
CERTIFICATE NUMBER:REVISION NUMBER:
9Bn02s
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS t'IO RIGHTS UPON THE CERTIFICATE HOLOER. THIS
CERTIFICATE OOES NOT AFFIRMATIVELY OR NEGATIVELY AMENO, EXTENO OR ALTER THE COVERAGE AFFOROEO BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S). AUTHORIZEO
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLOER.
IMPORTANT: lfthe certiflcat. holder is an ADDITIONAL lNSl,rREO, the policy(ies) must be endorsed. lf SUBROGATION lS WAIVED, subiect to
the lotms and condltions of the policy, certain pollcios may require an endorsement, A statement on this certlficate does not confea rlghts to thece.tificato holdor in li€u of such endorsoment(s).
Brown & Brown lnsuranco Services ln6
500 Vlctory Road, Marina Bay
North Quincy, MA 02171
fiRilEa"' e35 e35/s
PHONE 1617) 471-1220 FAx 16171479-5117
Edfi{E"., i6nnif6..wronski@bbrown.com
INSURERIS) AFFORDIN6 COVERAGE
TNSURERA: A-l,ll!. Mutlal lnsurance Company {4001 337s0
OC Porcellis Pizzeria & More LLC
C/O Cahdace Cook 130 Cottonwood Rd
Harwich, MA 02645
INSI]RER A
INSURER C
INSURER E
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTEO BELOW HAVE BEEN ISSUED TO THE INSURED NAMED AAOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT VYITH RESPECT TO WHICH THIS
CERTIFICATE IllAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFOROED BY THE POLICIES OESCRAED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS-
TYPE OF INSURANCE
S
NTED s
COIti/lERCIAL GENERAL LIAALITY
PERSONAL &I s
CEN€RAIAGGREGATE sL[IT
JECT
GEN'L
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HIRED AUTOS NON.OWNED
s
EACHIJMBRELLA IIAB
EXCESS r-rAB
OCCUR
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x T.
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E,L, DISEASE. EA EVPLOYEE 1!0.000.00
ANO EMPLOYERS' LIABIUTY
ANY PROPft ETOR/PARTNER/EXECUTIVE
OFFICEF'MEMBER EXCLUOED?
OESCRIPTION OF OPERAIONS bdow
4WC"400.70,11 052-2025A s|412025 st412026
. POLICYLIMITEL,
Candace Cook t Eleanor Keleh€r are exctud€d trom this policy offective 5/,U2025
may b. att2chod il mo€.pace iri
CERIIFICATE HOLDER CANCELLATION
SHOULDINY OF THE ABOVE OESCR|AED POUCIES BE CANCELLEO BEFORE
I!E- - El?LR4noN oarE THEREoF, NoncE nrLL ee oeltviiEo-'iNACCORDANCE WTH THE POLICY PROVISIONS.
Town of Yarmouth
1146 Route 28
South Yarmoulh, MA 02664
AUIHORIzEO REPRESENTAIVE
ACORD 25 (20r6103)rhe AcoRo name and roeo are resister", B:,1'j;',i3f;3Ro coRPo RATION. All rights reserved.
PRooucER 935.5
INSIJRED
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