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Home My WebLink AboutApp-CertsDetails lnternal Only License Restrictions/Conditions 105 C^tR 56 .009 res te count and coliform tests. Seatin '.4 Expiration Date' 1213112026 Business lnformation Business Name. Cape Cod Creamery Business Mailing Address (if different) Business E-Mail' alan@cccreamery.com Business Legal Entity Corporation Business Address in Yarmouth * 5 Theater Colony Rd., S. Yarmouth, MA 02664 Business Phone #' 508-280-5853 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* Alan Davis iranager/Contacl Person Name* Alan Davis FEIN Owner's Phone Number 508-280-5853 Manager / Contact Person Phone Numbef 508-280-5853 PLEASE LIST STAFF MEMBERS WHO HOLD THE FOLLOWING CERTIFICATIONS AND ATTACH COPIES OF CERTIFICATIONS Name ol Certified Food Protection Manage(S) All food service establishments are required to have at least one ('l) PERSON lN CHARGE on site during hours of operation Name and Title MEAGAN FREEMAN Address Telephone Number Email Emergency Telephone Number 508-280-5853 Please attach copies of certifications for all listed below: List all Certified Food Protection Managers* serve save 21 0032024.pdf List all employees with Allergen Certification* ALLERGY0301202s.pdf Establishment Operations Seasonal To Date 1111612026 Seasonal From Date 03t2812026 Location is Permanent Structure? Yes You must call for an inspection three (3) days prior to opening. Establishment Type Length of Permit Seasonal I I I I Continental Breakfast Non.Profit Residential Kitchen for Retail Sale Number of Seats lnside* 4 Common Victualler Wholesale Food Service Number of Seats Outside * 0 Total Seats Frozen Dessert I4 Monthly results must be submitted to the health department. tr tr I Retail Service Vending Food I Other 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. Seasonal: You must call for an inspection three (3) days prior to opening. Submitted by Statf Worker's Compensation lnsurance Affidavit I I Type of Business* I am an employer with employees * Business 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. tr lnsurance Company Name The Hill Group New England, LLc Policy # or Self-ins Lic. # wcc50050119952025A lnsurer's Address 973 lyannough rd Hyannis, Ma. 02601 Expiration Date 0510112026 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.' 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 ESTABLISHMENT (PAINTING, NEW EQUIPMENT, ETC.) MUST BE REPORTED TO AND APPROVED BY THE BOARD OF HEALTH PRIOR TO COMI\4ENCEMENT, RENOVATIONS MAY REQUIRE MA ENGINEER SITE PLAN. I acknowledge that I have read and understand the Notice information above* ServSafe ^latbnal Elestaur..nt,t\csoci.ition SerYSqfe' CERTIFICATION Io. rucressFrllv com/eirrg ihe :torxl<ros set loah tor *,e ServSoEo f&d Piotrctio,. l,/"no,.ler Cp.ti{i.olior Exdn\irotion which i5 o.crsdited by $e ANSI ilvnerlcon Nor onri Stodcttr lnslilvh) NCjonol Accredirdion Soord (ANABF Cor{er:^ e [o, Food P orec or rrFP] ER 5650 E/AM FOf,M NUMBER 1t29t2029 DATE CF EXIIqAI]O\ {c.,e.en:t.dr n,cqur'cm,:rtJ #0655 1129t2024 DAT E OT EX l,ccol lo*r opply sh llt^E, Nondd llhrr AEd6 d N...d tst !r Alsrdor 5.1&! UC 6oLb.lk .eld *r." p.,i!''@ ol ,l w J ...1t @l ^(^"bv IVEAGAN FREEIVAN l((tao[torrcaanl. ffi I Ccid 6 ri6 txt '. 61 2!3 5. wod, D6 Sul. J6U), OElro, lt @@6.€a! d sr{d.etioudr -F -----T--_--lll S0 LE/AIN asERvE TRAINING CERTIFICATE (lF Ctl]'IPLETI(Iil This certifies that na Raneo is awarded this certificate for Learn2Serve Food Allergy Training Course Hours 2.00 Conrplliion late 02/2At2025 Erpirrlion 0rte 02/2812028 >t U) teanl a senve This isyou. pocket cardwhich maybeused as prool ol trarning completion. This is not the actualFood Handler License. so you musl.lways check with your localHoEltn oepartmont and malre sureyou tultillalllhe requirem€nts belore applying for 6mployment. C.rtlficale { AlSl Nationat Accrcdttalion Boanl ACCREDITED ------ti!lF!lt'5- CEBTIFICATE ISSUER #0s75 Sa.nantha l'lcnlaibaoo Ch perating 0fricer Ir'iii I k i itll:All ,S NON-lpifilrt[ /'xr]! F 0! 'iitr llrrrr'..r:.1 rr. r.rdi :l|ri.r ll)r: lir,rrr l. j').".\. : .'l)i:ttt; i )tr\ * L.ei2s.m f.od l&rw Tr.i ng c0.!. - ^r1"" Quesrions? support&!360trarning com (, "lU o.Qo'CERTIFICATE OF LIABILITY INSURANCE DATE IT /DOTYYYY) 0111312026 THIS CERTIFICATE IS ISSUED AS A I{ATTER OF II{FOR ANON ONLY AND CONFERS NO RIGHIS UPON IHE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMENO, EXTEND OR ALTER THE COVERAGE AFFOROEO BY THE POLICIES BELOW. THtS CERnFTCATE OF TNSURANCE DOES NOT CONSTTTUTE A CONTRACT BETWEEN THE tSSU|NG TNSURER(S), AUTHORIZED REPRESENTATIVE OR PROOUCER, ANO THE CERTIFICATE HOLOER, IMPORTANT: It the c€rtlflcate hold€. is an AOOITIOi{AL INSUREO, the policy(ie6) mu6t have ADDITIONAL INSUREO provisions or b€ andorsed tt SUBROGATION lS WAIVED, rubroct lo the terma and conditionB of the policy, c.rtain policios may ioquir6 an €ndorsement. A statem€nt on this certifical€ do€6 not conler rights to th6 certificate holder ln lieu ol suah ondo66ment(s). The Hilb Group New England, LLC 9T3lyannough Road Hyannrs MA 02601 CONTACT PHO'IE (800)64G1620 keeves@hilbgroup.com IXSU RER(S) AFFORUiIG COVERAGE tNauRER a. Tri'Slale lnsuranca Co o, Minnosota 31003 INSUREO CAPE COO CREAMERY LLC 5 THEATER COLONY RO SOUTH YARMOUTH txlrrRER 6 . Assocraled Employ€rs lnsurance Co r 1104 INSUf,EN E COVERAGES CERTIFICATE NUMBER REVISION NUMBER: THIS IS TO CER]IFY THAT IHE POLICIES OF INSURANCE LISTED BELOW HAVE EEEN ISSUED TO THE INSURED NAMEDABOVE FOR THE POLICY PERIOD INDICATED, NOIWIHSTANDING ANY REOUIREMENT, IERM OR COND ION OF ANY CONTRACT OR OTHER DOCUMENT WIIH RESPECT TO WHICH THIS CERIIFICAIE MAY 8E ISSUED OR MAY PERTAIN, THE INSURANCE AFFOROEO EYTHE POLICIES OESCRIEED HEREIN IS SUBJECT TOALL THE lERMS, EXCLUSIONS ANO CONOITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE AEEN REDUCEO BY PAIO CLAIMS CO MERCIALGENERAL LIABILITY ffi o..r" CEN I,ACGREGATE llMllAPPIIES PERr ffi,o" AOV5632004-11 o1t10t2026 01n012027 EACH OCCIJRRENCE t 1.0o0,0o0 DAMAGEIORENIEO PREMISES lE. ccurencs)t 300,000 MED LXP lAny on. @e.)t 1O.OOO PERSONT A AOV INJI]RY r 1.0o0.o00 i 2,000,000 pRooucTs . coMP/oP,lcc r 2,000,000 $ HIREO SCHEOUIED NOtlowNEo 4D45437091-16 41110t2026 o1t1012027 COMBINEO SINGTE LIMIT i 1.0O0.000 aOOILY lNJl.rRY lPs BB6)! EOOILY INJURY (P6r ac.donl)$ r 250.000 X EICESS L|AA x occlJF 4DV5632004-11 o1t10t2426 EACH OCCURR€NCE 3 3.000.000 AGGREGATE r 3.000.000 RETENIION t 5 B $roRxERs corPE sattot{ Ai{O E'PIOYERS' UABITITY ANY PROPRIETOR,IPARINER/EXECUTIVE OFFICER/MEMBER EXCf UDEO? OFSCRIPTION OF OPFAATIONS h.lm N wcc50050119952025A o5lo1t2a25 osto1t2026 X SIAIUIE OTH. ER E L EACI]ACCIOENT r 1,0o0.000 t 1,000.000 E.L DISEASE - POIICY LIMIT r i,0o0,000 OESCRIPTIOII OF OPERAIIOIIII / LOCATIONS MNICIES (ACOiD 1Ol, Addlllon.l R.m.*. S.h.dul., m.y b. .tt..h.d r nor. rp.c. r. ..qun.d) RE LOC 5 Theater Colony Road. Soulh Yarmouth. MA 02664 lnsoranc€ coveGgo is limiled lo lhe terms, conditions, exdusions, olher limilatons and €hdorsemenls. Nothlng conlainad in the certifEate of insurance shall be deemed to have allered, waived, or exlended lhecoverage provded by the policy provlsions. CERTIFICATE HOLDER CANCELLAIION 1146 Roule 28 Solrlh Yarmoulh MA O26M STIOULD ANY OT THE ABOVE OESCRIBED POLICIES BE CANCELLED AETORE THE EXPIRATIOI'I DATE THEREOF, NOnCE WLL BE OELTVEREO tN ACCORDAiICE IVITH THE POIICY PROVISIONS. AUIHORIZED REPRESENTATIVE acoRD 25 (20t6/03) O '1988.2015 ACORD CORPORATION. Alt rights roserved The ACORD namc and logo a.e regl6to.ed marks ofACORD a1t10t2021 I I