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Home My WebLink AboutApp-CertsDetails lnternal Only License Restrictions/Conditions Seating: 130 Expiration Date- 1213112026 Business lnformation Business Name* Ryan Family Amusements Business Mailing Address (il different) Business E.Mail' prizeking@ryanfamily.com Business Legal Entity lndividual Business Address in Yarmouth * 1067 Route 28, S. Yarmouth, MA02664 Business Phone #' 508-394-5644 Business Type' Retail Service Corporation Name (if applicable) Tax lD (FEIN or SSN)' FEIN ls this a NAME CHANGE? No Owner / Manager lnformation Owner's Name* William Campbell Manager/Contact Person Name* Jahni Clarke Name and Title Jahni Clarke 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 ..--*1210 Owner's Phone Number 508-326-1936 Manager / Contacl Person Phone Number* 774-994-1214 Address Telephone Number 774-994-1214 Emergency Telephone Number 508-394-5644 Please attach copies of certifications for all listed below: List all Certified Food Protection ilanagers- Jahni Clarke List all employees certified in Anti-Choke' Jahni Clarke List all employees with Allergen Certification- Jahni Clarke Establishment Operations Length of Permit Annual Email jahni@ryanfamily.com Location is Permanent Structure? Yes Establishment Type I I I I I I Continental Breakfast Non.Profit Residential Kitchen for Retail Sale Number of Seats lnside- 130 Tolal Seats 130 Retail Service Common Victualler Wholesale Food Service Frozen Dessert Vending Food I I I Number of Seats Outside * 0 II 0ther Name Change Only Affidavit New construction, remodel or conversion requires an Occupancy Permit from the Building Department in order to receive a valid Food Permit. Submitted by Staff Worker's Compensation lnsurance Affidavit Type of Business*Business We are a corporation and its officers have exercised their right of exemption per c. 1 52, $ 1(4), and we have no employees. [No workers' comp. insurance required]** Food / Retail Service t 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 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 that I have read and understand the Notice information above* tr CTRTTFTCATE oF ATTERGEN AwIRENE S S TnruN ING Name of Recipient: JAHNI cLARKE Certifcate \gm[s1. ssrsaer Date of completion' l oiel2022 Date of ExPiratioi' 1otst2o21 lreucd By: The aboae-named person h bereby issaed this cettfcate for completing an allergen aroarenets truinitg Program recqnized by tbe Massachusetts Department of Publk Health in accordance witb 105 CMR 590.009(G)(3)(a). n lllRt _\_ NATIONAL . RESTAURANT ASSOCIATTONo 800.765.2122 wwwJestaurant.org Massachusctts Rcstaurant Association 333 Tirnpikc Road, Suitc 102 Southborough, MA 01772 508-303-9905 www.marE6tauranta$oc. or8 ,^T rl 'l v, I I n* ertrrcote w;ll bc validJbrfre (5) yarsfrom date of completian. ServSafe National Restaurant Association SerYSqfe' CERTIFICATION JAHNI CLARKE for successfully completing he slondords set forth for fie ServSob@ Food Prolection Monoger Cedificolion &ominotion, which is occredited by the Americon Notionol Stondords lnslituie {ANSllConfurence for Food Protection {CFP}. ER 5589 EXAM TORM NUMSER 11 t15t202 11t15t2027 DATE OF EX DATE OF EXPIRATION for recertificotion requirements.Locol lows opply iolion Solutions 5 Ei.ffitEffi ilst /..:'.t\z/ #0655 sc"Sof, logo oo rodmrlc ol ilE l.xAE[ . l.idridd RBtoudnr Arqi.iidrD orJ *E oE dais. G.Ei !t sii gr'ii.d 6t 233 S. Wod, D.i€,5!n 3600, Cii@go, lL 60606{383 d S66ole6dturd$.d9. ACCsEDIIEO PNOGN lrEia ll.d@l Strrt (,. t6tt b ad t. G@llrc lu fod Pbtedff c t HCATT 229 o) / @ tE ldrd*r oI tE trotiml R.doE A.4ioriqI R8brdrr AiEtrim HEr'tulr@nddb. {NnAEl @8-2t Alliofr ,i' dcffir conno! b. EpEduc.d d 61,* ffi&@ I a Berrley Comp.ny lnformollon Poge Policy #: KRM703764886 I . Nomed lnsured ond Moiling Address Ryon Fomily Amusements LLC I l6 Wolerhouse Rood Buzords Boy. MA 92532 Policy Workers Compensollon ond Employers tloblllty lnsuronce Policy #: KRM703764886 lnsurer: Key Rlsk lnsurqnce Compony NCCI Conier #: 370t14 PO 8ox 49129 Greensboro, NC 27419 Agency lnformotion Mqrsh & Mclennon Agency, LLC 2211295 l0l N Slorcrest Drive Cleorwoler, FL 33755 FEIN: r-"'1210 Agency 10:.2211295 Risk lD: 917565287 Bureou File No.: Other wokploces not shown obove: See Schedule ot Locotlons Enllly of lnsured: Limited liobilily Compony (LLC) 2. The policy period is from 1012812025 to 1012812026 l2:olAM Slondord Ilme ot lhe insured's moiling oddress. 3. A. \^/orkers Compensolion lnsuronce: Pod One of the policy opplies to the Workers Compensolion Low of lhe stote(s) lhted here: Rl, NH, n A B. Employers Liobilily lnsuronce: Port Two of lhe policy opplies lo work in eoch stole listed in ltem 3.A. The limih of our liobility under Port Two ore: Bodily lniury by Accident $t,000.000 eoch occidenl Bodily lniury by Diseose $1.000,000 policy limil Bodily lnjury by Diseose 51,000,000 eoch employee C. Olher Stotes lnsuronce: Porl Three ot the policy opplies to the siotes, if ony. lisled here: All sloles ond U.S. lerrltorles excepl Norlh Dokolo, ohlo, woshlngton, Wyomlng, Puerlo Rlco, ond lhe U.S. Mrgln lslonds, ond sloles designoled ln llem 3.4. ol lhe lntormotlon Poge. D. Ihis policy includes these endorsemenls ond schedules: See Schedule ol Endotsemenls 4, Ihe premium for th'6 policy Wll be determined by our Monuols of Rules, Clossificoiions, Roles ond Roting Plons. All intormotion required below is subject to verificolion ond chonge by oudit. See Schedule ol Closslf,collons Experience Modilicolion 0.95 Totol Estimoted Annuol Premium 534,945 Minimum Premium S0 Totol Blimoled surchorges ond Assessmenls 91,418 Expense Conslont SfilE Totol Eslimoted Cosl 536,363 s€e slgnoture tom of Aulhorlzed Reptesenlollves Countersigned By lncludes cop[lghled moleriolol the Notionol Counci on Compensolign lnsuronce, lnc. wlth lheir permission. wcm000lA (Ed 05 88) lnnrec K€y Ri* lnsuronce Compgny Bsued: 10/2912025 (ey RIsk I keydd(com PoOe I of I