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HomeMy WebLinkAboutVendor Agreement Ins 1-2 Signed Adiel Corn.pdf 1 LICENSE AGREEMENT 2 June 24, 2024 THIS LICENSE AGREEMENT("Agreement") is dated and is between 3 Adiel Corn sole proprietor (name of contractor), a (type of entity) 4 ("LICENSEE"), and the County of Fresno, a political subdivision of the State of California 5 ("COUNTY") (collectively, "Parties"). 6 Choinumni Park WHEREAS, COUNTY owns and/or operates (name of park) 7 26501 Pine Flat Road, Sanger, CA 93657 located at g (address of park), 8 hereinafter referred to as "PREMISES;" and, 9 WHEREAS, COUNTY and LICENSEE mutually desire to allow LICENSEE to use the 10 sales of corn,tostilocos,duritos,papitas PREMISES for the operation of snack and snow cones service unit(s) or services, 11 hereinafter referred to as "SERVICE"; and, 12 WHEREAS, COUNTY finds that LICENSEE'S operation of said SERVICE is in the 13 public interest and that the LICENSEE'S operating on the PREMISES will not substantially 14 conflict or interfere with the use of the PREMISES by COUNTY or County residents. 15 NOW, THEREFORE, in consideration of the mutual promises, covenants and 16 conditions herein contained, the Parties and each of them do agree as follows: 17 1. GRANT OF LICENSE: COUNTY grants to LICENSEE a non-exclusive right to 18 provide SERVICE on the PREMISES for the benefit of employees, guests, and patrons of the 19 PREMISES ("LICENSE"). LICENSEE must have LICENSEE'S business name printed legibly 20 and visible on all vehicles and equipment operating on the PREMISES. Failure to do so may 21 result in not being allowed access to the PREMISES. The LICENSE is personal to the 22 LICENSEE. The LICENSE does not constitute a lease. By grant of this LICENSE, the 23 COUNTY does not grant a possessory interest in the PREMISES under this LICENSE. 24 2. LOCATION: COUNTY shall designate areas within the PREMISES, as shown in 25 Exhibit "A"which is attached hereto and by this reference incorporated herein, as the location 26 for LICENSEE'S service equipment. LICENSEE shall operate solely from the designated 27 location(s) specified in . LICENSEE shall not solicit customers by any means including signs, 28 COUNTY OFFRESNO Fresno,California 1 1 handouts or amplified sounds outside of the designated location(s). LICENSEE shall not affix 2 signs or banners on trees, bushes or County owned structures. Said location(s) may be 3 changed upon mutual written agreement between the Parties. The Service facilities, and all 4 ancillary equipment, shall be removed at the end of each day of operation. No equipment shall 5 be left at the PREMISES overnight. LICENSEE'S setup shall not interfere with pedestrian 6 traffic. Ample travel ways shall be maintained at all times by LICENSEE. 7 3. TERM 8 The term of this Agreement shall be for 6 months, commencing 9 December 31, 2024 unless terminated earlier in the manner specified below in paragraph 10 4 "Termination". Upon expiration of said term as established above, this Agreement shall not 11 automatically renew and a new license application will need to be submitted. 12 4. TERMINATION: 13 A. Breach of Contract- The COUNTY may immediately suspend or terminate this 14 Agreement in whole or in part, upon the determination by COUNTY that there 15 is on the part of the LICENSEE: 16 1) Improperly performed service; 17 2) A failure to comply with any terms of this Agreement; or 18 3) A substantially incorrect or incomplete report or false information 19 submitted to the COUNTY. 20 In no event shall any receipt of any funds by the COUNTY constitute a waiver by the COUNTY 21 of any breach of this Agreement or any default which may then exist on the part of the 22 LICENSEE with regard to any additional funds payable to COUNTY in connection with this 23 Agreement. Neither shall such payment impair or prejudice any remedy available to the 24 COUNTY with respect to the breach or default for any additional funds owed by LICENSEE to 25 COUNTY. 26 In the event of breach of this Agreement by LICENSEE, COUNTY may immediately terminate 27 this Agreement and LICENSEE will not be eligible for future agreements with the COUNTY for 28 Services. COUNTY OF FRESNO Fresno,California 2 I B. Without Cause- Under circumstances other than those set forth above, this 2 Agreement may be terminated by either the COUNTY or LICENSEE upon the 3 giving of fifteen (15) days advance written notice of an intention to terminate to the 4 other party. 5 5. COMPENSATION: In consideration for granting this non-exclusive Agreement, 6 LICENSEE shall pay to COUNTY the sum of ten percent(10%) of the gross daily sales by the 7 5th of each month for the use of the PREMISES. If payment is not made by the 7th of each 8 month, a 10% late penalty charge will be due and payable with said payment. If payment is not 9 made within two (2) weeks of the first of each month, this Agreement may be terminated 10 immediately and the LICENSEE will not be eligible to continue to offer SERVICES within the 11 PREMISES. Payment shall be made to the County of Fresno, Department of Public Works and 12 Planning, ATTN: Resources Manager—2220 Tulare Street, 6th Floor, Fresno, CA 93721-2120. 13 6. DAMAGE DEPOSIT: Upon execution of Agreement, the LICENSEE shall provide 14 a damage deposit of Five Hundred Dollars ($500) to the COUNTY. The damage deposit is 15 refundable, provided however, such deposit shall not be refunded to the extent that the 16 COUNTY incurs costs or expenses related to the LICENSEE's performance of Service. 17 7. INDEPENDENT CONTRACTOR: In performance of the work, duties and 18 obligations assumed by LICENSEE under this Agreement, it is mutually understood and 19 agreed that LICENSEE, including any and all of the LICENSEE'S officers, agents, and 20 employees will at all times be acting and performing as an independent contractor, and shall 21 act in an independent capacity and not as an officer, agent, servant, employee,joint venturer, 22 partner, or associate of the COUNTY. Furthermore, COUNTY shall have no right to control or 23 supervise or direct the manner or method by which LICENSEE shall perform its work and 24 function. However, COUNTY shall retain the right to administer this Agreement so as to verify 25 that LICENSEE is performing its obligations in accordance with the terms and conditions 26 thereof. LICENSEE and COUNTY shall comply with all applicable provisions of law and the 27 rules and regulations, if any, of governmental authorities having jurisdiction over matters the 28 subject thereof. COUNTY OF FRESNO Fresno,California 3 1 Because of its status as an independent contractor, LICENSEE shall have absolutely 2 no right to employment rights and benefits available to COUNTY employees. LICENSEE shall 3 be solely liable and responsible for providing to, or on behalf of, its employees all legally 4 required employee benefits. In addition, LICENSEE shall be solely responsible and save 5 COUNTY harmless from all matters relating to payment of LICENSEE'S employees, including 6 compliance with Social Security withholding and all other regulations governing such matters. 7 It is acknowledged that during the term of this Agreement, LICENSEE may be providing 8 services to others unrelated to the COUNTY or to this Agreement. 9 8. MODIFICATION: Any matters of this Agreement may be modified from time to 10 time by the written consent of all the Parties without, in any way, affecting the remainder. 11 9. NON-ASSIGNMENT: Neither party shall assign, transfer or sub-contract this 12 Agreement or its respective rights or duties under this Agreement without the prior written 13 consent of the other party. 14 10. INDEMNITY AND DEFENSE: LICENSEE shall indemnify and hold harmless and 15 defend the COUNTY (including its officers, agents, employees, and volunteers) against all 16 claims, demands, injuries, damages, costs, expenses (including attorney fees and costs), fines, 17 penalties, and liabilities of any kind to the COUNTY, the LICENSEE, or any third party that 18 arise from or relate to the performance or failure to perform by the LICENSEE (or any of its 19 officers, agents, sublicensees, or employees) under this Agreement. The COUNTY may 20 conduct or participate in its own defense without affecting the LICENSEE's obligation to 21 indemnify and hold harmless or defend the County. This section survives the termination of this 22 Agreement. 23 11. INSURANCE: The LICENSEE shall comply with all the insurance requirements in 24 Exhibit B to this Agreement. 25 12. PERMITS: LICENSEE shall provide to the foregoing address a copy of any and 26 all permits required by the local governing authority(ies), such as a business license required 27 by the local applicable authority, and a valid Permit To Operate ("Permit") issued by the County 28 of Fresno, Department of Community Health, Environmental Health Division not later than COUNTY OF FRESNO Fresno,California 4 1 fourteen (14) days following the beginning of the Term of this Agreement. LICENSEE 2 understands that said Permit must be obtained on an annual basis and LICENSEE shall 3 provide a copy of any new annual Permit to the aforementioned address within fourteen (14) 4 days of obtaining the Permit. LICENSEE understands that Permits are not transferable or 5 refundable and said Permits become void upon change of ownership. LICENSEE also 6 understands that any new owner(s) and/or operator(s), if an assignment is approved by 7 COUNTY in writing, as required in Section 9 above, must obtain a new Permit in his/her/its own 8 name prior to beginning operation. 9 13. AUDITS AND INSPECTIONS: The LICENSEE shall at any time during business 10 hours, and as often as the COUNTY may deem necessary, make available to the COUNTY for 11 examination all of its records and data with respect to the matters covered by this Agreement. 12 The LICENSEE shall, upon request by the COUNTY, allow the COUNTY to audit and inspect 13 all of such records and data necessary to ensure LICENSEE'S compliance with the terms of 14 this Agreement. 15 14. LITTER AND CLEANUP: LICENSEE shall provide adequate trash disposal units 16 adjacent to the area being utilized and shall be responsible for trash removal and area cleanup, 17 including raking or wet mopping on an as needed basis, but no less often than daily. 18 LICENSEE shall, at the end of each day, inspect the park for litter derived from the sales of his 19 or her Services and remove such litter. LICENSEE shall prevent staining of any grass, cement 20 walkway or asphalt parking area by ensuring that no residue from the unit or food preparation 21 will drip on the grass, concrete or asphalt. Trash containers are to be removed nightly. 22 15. SPECIFICATIONS: LICENSEE shall only sell products or services from mobile 23 unit(s). No general merchandise shall be sold other than those items specifically approved by 24 COUNTY as listed in Exhibit C. No products with glass containers will be allowed to be sold. 25 LICENSEE shall comply with all of the following: 26 A. The California Retail Food Code (Part 7 of Division 104 of the California Health 27 and Safety Code, commencing with Section 113700, hereinafter"CRFC") and regulations 28 promulgated thereunder, including but not limited to any future laws and regulations COUNTY OFFRESNO Fresno,California 5 1 enacted/promulgated to replace or supplement CRFC; and, 2 B. All County of Fresno Ordinances, including all regulations, policies and 3 requirements of the County of Fresno's Department of Community Health; and, 4 C. All health guidance and regulations issued by the State of California and the 5 Fresno County Department of Public Health; and, 6 D. Any other laws, regulations or ordinances as they relate to mobile/portable food 7 concession units. 8 16. UTILITIES AND DISPOSAL: All mobile units operated by the LICENSEE must be 9 self-contained. Electrical power, potable water and sewage disposal is not available. 10 17. DAYS OF OPERATION: LICENSEE may provide Service seven days per week 11 during standard park operational hours, except on days when the PREMISES are closed by the 12 COUNTY or are rented by the COUNTY, in their entirety and on an exclusive basis, to another 13 person or entity for the purpose of hosting or conducting a private or special event. 14 18. GOVERNING LAW: Venue for any action arising out of or relating to this 15 Agreement shall only be in Fresno County, California. The rights and obligations of the Parties 16 and all interpretation and performance of this Agreement shall be governed in all respects by 17 the laws of the State of California. 18 19. POSSESSORY INTEREST TAX: The Parties acknowledge that California 19 Revenue & Taxation Code § 107.6 provides, in relevant part, the following: "(a) The state or 20 any local public entity of government, when entering into a written contract with a private party 21 whereby a possessory interest subject to property taxation may be created, shall include, or 22 cause to be included, in that contract, a statement that the property interest may be subject to 23 property taxation if created, and that the party in whom the possessory interest is vested may 24 be subject to the payment of property taxes levied on the interest."Accordingly, although the 25 COUNTY does not grant a possessory interest under this License, the Parties agree that the 26 COUNTY is a 'local public entity of government', and that LICENSEE is a "private party", 27 respectively, within the meaning of California Revenue & Taxation Code §107.6(a), and that 28 this License(to the extent that it may be necessary under California Revenue &Taxation Code COUNTY OF FRESNO Fresno,California 6 1 §107.6(a) for the Parties to acknowledge and agree herein with respect to this License) is a 2 "contract,"which may create a possessory interest that may be subject to property taxation 3 pursuant to California Revenue & Taxation Code §107.6(a). In this regard, under this License, 4 LICENSEE acknowledges and agrees that (i) the property interest that may be created by this 5 License may be subject to property taxation, and (ii) LICENSEE (i.e., the party in whom the 6 possessory interest, if any, is vested) shall, at its sole cost and expense, be subject to the 7 direct payment of property taxes levied on such interest, and shall directly pay any and all 8 property taxes levied on such interest, and any interest, penalties, or charges thereon for 9 LICENSEE'S late payment of, or failure to pay such amounts when they are due and payable. 10 20. NOTICES: Any and all notices between either party under the terms of this 11 Agreement or by law shall be in writing and shall be deemed to be duly given if served when 12 personally delivered or deposited into the United States mail, with postage prepaid, registered, 13 and addressed to the respective addresses stated as follows: 14 COUNTY LICENSEE County of Fresno Olivia Olivera Trinidad 15 Steven E. White, Director Owner Dept. of Public Works and Planning Adiel Corn 16 Resources Division Manager 2220 Tulare Street, 6th Floor 1639 s Orange 17 Fresno, CA 93721-2120 Fresno,CA 93702 (559) 600-4078 --55Q-8�1-28 18 parks@fresnocountyca.gov angellaureano502@gmail.com 19 20 21. ELECTRONIC SIGNATURES: The Parties agree that this Agreement may be 21 executed by electronic signature as provided in this section. 22 (A) An "electronic signature" means any symbol or process intended by an individual 23 signing this Agreement to represent their signature, including but not limited to (1) a digital 24 signature; (2) a faxed version of an original handwritten signature; or (3) an electronically 25 scanned and transmitted (for example by PDF document) of a handwritten signature. 26 (B) Each electronic signature affixed or attached to this Agreement(1) is deemed 27 equivalent to a valid original handwritten signature of the person signing this Agreement for all 28 purposes, including but not limited to evidentiary proof in any administrative or judicial COUNTY OF FRESNO Fresno,California 7 I proceeding, and (2) has the same force and effect as the valid original handwritten signature of 2 that person. 3 (C)The provisions of this section satisfy the requirements of Civil Code section 1633.5, 4 subdivision (b), in the Uniform Electronic Transaction Act(Civil Code, Division 3, Part 2, Title 5 2.5, beginning with section 1633.1). 6 (D) Each party using a digital signature represents that it has undertaken and satisfied 7 the requirements of Government Code section 16.5, subdivision (a), paragraphs (1) through 8 (5), and agrees that each other party may rely upon that representation. 9 (E)This Agreement is not conditioned upon the parties conducting the transactions 10 under it by electronic means and either party may sign this Agreement with an original 11 handwritten signature. 12 22. ENTIRE AGREEMENT: This Agreement constitutes the entire agreement 13 between the LICENSEE and COUNTY with respect to the subject matter hereof and 14 supersedes all previous Agreement negotiations, proposals, commitments, writings, 15 advertisements, publications, and understandings of any nature whatsoever unless expressly 16 included in this Agreement. 17 18 19 20 21 22 23 24 25 26 27 28 COUNTY OF FRESNO Fresno,California 8 I IN WITNESS WHEREOF, the Parties hereto have caused this Agreement to be executed as of 2 the day and year first above written. 3 LICENSEE COUNTY OF FRESNO 4 Digitally signed by Steve Steve White Date: 'S ` / Date:2024.06.26 BY_ / l r//u �YI f.�. .1...�+ By 11:17:31-07'00' Title cm)e r Steven E. White, Director 6 Department of Public Works and Planning 7 Date: �- 2�f'ZN APPROVED AS TO LEGAL FORM: 8 Daniel Cederborg, County Counsel Natalie fZ, Digitally signed by Natalie 9 f\ R.Nutlall y Nuttall Date:2024.06.28 10 B 10:40:18-07'00' Deputy 11 FOR ACCOUNTING USE ONLY: 12 Budget Unit No.: 7910 Fund No.: 0001 13 Account No.: 3400 14 15 G57910ParksBGmundslPubtic\Vendors12024.03.22 Vendor Agreement(Ins 1-2).docx 16 17 18 19 20 21 22 23 24 25 26 27 28 COUNTY OF FRESNO Fresno,California 9 - . ? s'• fir e:'' a1 Xt •, ram, - � ">" �•, �� -�"" ,���}��. •. Aw aIK mp , IL c so cu QJ IL M aj ID v v7 ry ag' r) .�"' ,�q.L•l s +Ard- '� Mir Vill .40 Ar AAK ter, --tr ,� �' .•to-•�_ �� ., 1 t a.� JF. -• J N 'I' AW a f ��mdr.� -�j. •fir - '`��/ AIL .may ,� •� .i.' ' •t• �•r , Or + w f A Exhibit B 1 Insurance Requirements 2 1. Required Policies Without limiting the County's right to obtain indemnification from the Licensee or any third 3 parties, Licensee, at its sole expense, shall maintain in full force and effect the following 4 insurance policies throughout the term of this Agreement. (A) Commercial General Liability. Commercial general liability insurance with limits of not 5 less than One Million Dollars ($1,000,000) per occurrence and an annual aggregate of 6 Two Million Dollars ($2,000,000). This policy must be issued on a per occurrence basis. Coverage must include products, completed operations, property damage, bodily injury, 7 personal injury, and advertising injury. The Licensee shall obtain an endorsement to this policy naming the County of Fresno, its officers, agents, employees, and volunteers, 8 individually and collectively, as additional insureds, but only insofar as the operations under this Agreement are concerned. Such coverage for additional insureds will apply 9 as primary insurance and any other insurance, or self-insurance, maintained by the 10 County is excess only and not contributing with insurance provided under the Licensee's policy. 11 (B) Automobile Liability. Automobile liability insurance with limits of not less than One 12 Million Dollars ($1,000,000) per occurrence for bodily injury and for property damages. Coverage must include any auto used in connection with this Agreement. 13 (C)Workers Compensation. Workers compensation insurance as required by the laws of 14 the State of California with statutory limits. (D) Employer's Liability. Employer's liability insurance with limits of not less than One 15 Million Dollars ($1,000,000) per occurrence for bodily injury and for disease. 16 2. Additional Requirements 17 (A) Verification of Coverage. Within 30 days after the Licensee signs this Agreement, and 18 at any time during the term of this Agreement as requested by the County's Risk Manager or the County Administrative Office, the Contractor shall deliver, or cause its 19 broker or producer to deliver, to the County Risk Manager, at 2220 Tulare Street, 16th Floor, Fresno, California 93721, or HRRiskManagement@fresnocountyca.gov, and by 20 mail or email to the person identified to receive notices under this Agreement, certificates of insurance and endorsements for all of the coverages required under this 21 Agreement. 22 (i) Each insurance certificate must state that: (1) the insurance coverage has been obtained and is in full force; (2) the County, its officers, agents, employees, and 23 volunteers are not responsible for any premiums on the policy; and (3)the 24 Licensee has waived its right to recover from the County, its officers, agents, employees, and volunteers any amounts paid under any insurance policy 25 required by this Agreement and that waiver does not invalidate the insurance policy. 26 (ii) The commercial general liability insurance certificate must also state, and 27 include an endorsement, that the County of Fresno, its officers, agents, employees, and volunteers, individually and collectively, are additional insureds 28 insofar as the operations under this Agreement are concerned. The commercial COUNTY OF FRESNO Fresno,California 10 Exhibit B 1 general liability insurance certificate must also state that the coverage shall apply as primary insurance and any other insurance, or self-insurance, 2 maintained by the County shall be excess only and not contributing with insurance provided under the Licensee's policy. 3 (iii) The automobile liability insurance certificate must state that the policy covers 4 any auto used in connection with this Agreement. 5 (B) Acceptability of Insurers. All insurance policies required under this Agreement must be issued by admitted insurers licensed to do business in the State of California and 6 possessing at all times during the term of this Agreement an A.M. Best, Inc. rating of no less than A: VI I. 7 (C) Notice of Cancellation or Change. For each insurance policy required under this 8 Agreement, the Licensee shall provide to the County, or ensure that the policy requires the insurer to provide to the County, written notice of any cancellation or change in the 9 policy as required in this paragraph. For cancellation of the policy for nonpayment of premium, the Licensee shall, or shall cause the insurer to, provide written notice to the 10 County not less than 10 days in advance of cancellation. For cancellation of the policy 11 for any other reason, and for any other change to the policy, the Licensee shall, or shall cause the insurer to, provide written notice to the County not less than 30 days in 12 advance of cancellation or change. The County in its sole discretion may determine that the failure of the Licensee or its insurer to timely provide a written notice required by 13 this paragraph is a breach of this Agreement. 14 (D) County's Entitlement to Greater Coverage. If the Licensee has or obtains insurance with broader coverage, higher limits, or both, than what is required under this 15 Agreement, then the County requires and is entitled to the broader coverage, higher limits, or both. To that end, the Licensee shall deliver, or cause its broker or producer to 16 deliver, to the County's Risk Manager certificates of insurance and endorsements for all 17 of the coverages that have such broader coverage, higher limits, or both, as required under this Agreement. 18 (E) Waiver of Subrogation. The Licensee waives any right to recover from the County, its 19 officers, agents, employees, and volunteers any amounts paid under the policy of worker's compensation insurance required by this Agreement. The Licensee is solely 20 responsible to obtain any policy endorsement that may be necessary to accomplish that waiver, but the Licensee's waiver of subrogation under this paragraph is effective 21 whether or not the Licensee obtains such an endorsement. 22 (F) County's Remedy for Contractor's Failure to Maintain. If the Licensee fails to keep in effect at all times any insurance coverage required under this Agreement, the County 23 may, in addition to any other remedies it may have, suspend or terminate this 24 Agreement upon the occurrence of that failure, or purchase such insurance coverage, and charge the cost of that coverage to the Licensee. The County may offset such 25 charges against any amounts owed by the County to the Licensee under this Agreement. 26 27 28 COUNTY OFFRESNO Fresno,California 11 Ac CERTIFICATE OF LIABILITY INSURANCE DATE(21/2024 Y, 06/21/zo2a THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE.DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy()es)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Maria C Lopez NAME: Maria C Lopez(Farmers Insurance 9546EX) PHONE 559-252-2345 1 FAX 559.559-8931 A/C No): 407 S Clovis Ave#105 E-MAIL mlopez2@farmersagent.com ADDRESS; Fresno Ca.93727 INSURERS AFFORDING COVERAGE NAIL N INSURERA:- Scottsdale Insurance Company 41297 INSURED INSURER B Olivia Trinidad Olivera - INSURER C: DBA-Adiel Corn - INSURER D 404 D St INSURER E: Orange Cove Ca 93646 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. 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 AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR L7R TYPE OF INSURANCE ADDL SUER POLICY NUMBER MMIDDPOLICY EFF MM�D%YYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE Fx_1 OCCUR PREMISES Ha occurrence $ 100,000 MED EXP(Any,one person) $ 5000 A Y Y CPS4065074 03/20/2024 03/20/2025 PERSONAL BADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIESPER: GENERAL AGGREGATE $ 2,000,000 X 'POLICY❑JEo LOC PRODUCTS-COMP/OPAGG $ 1,000,000 OTHER: $ AUTOMOBILE UABILrTY - - COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTYDAMAGE AUTOS ONLY AUTOS ONLY Per accident $ $ UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION $ WORKERS COMPENSATION -PER OT H- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETORIPARTNER/EXECUTIVE ❑ NIA E.L EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) ' EL.DISEASE-E'AEMPLOYEE $ If yes,describe under E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Additional Insured-County of Fresno,2220 Tulare St.,Fresno Ca.93721 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN County Of Fresno ACCORDANCE WITH THE POLICY PROVISIONS. 2220 Tulare St Fresno Ca.93721 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD ORPO ATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD June 24, 2024 Olivia Olivera Trinidad Owner Adiel Corn 1639 S Orange Fresno, CA 93702 559-854-3428 To County of Fresno Parks: I, Olivia Olivera Trinidad, am the owner of Adiel Corn and do not use my personal vehicle for county purposes in connection with the Agreement. Should I use my personal vehicle for county purposes in connection with the Agreement, I will submit the appropriate insurance immediately. Thank you, a Olivia Olivera Trinidad t,)ch tb-A- 13 June 24, 2024 Olivia Olivera Trinidad Owner Adiel Corn 1639 S Orange Fresno, CA 93702 559-854-3428 To County of Fresno Parks: I, Olivia Olivera Trinidad, owner of Adiel Corn, am exempt from the State's workers' compensation requirements because I have no employees and agree to hold the County harmless from loss or liability for such. Thank you, 0 .k A�\C01 I-L)ty IV tjA Olivia Olivera Trinidad t!&h c., MOBILE MENU/CALCARD 2024 Business Name Date Business Address I FA Business Owner Name Food Business Owner Telephone Commissary Name Commissary Address 0 List complete MENU that you will be serving (do not list prices): See attached menu ❑ e,IQ [C s y po S ",I; 1 h VI5 At�t F;rc - , II y s 0 List all EMPLOYEES and CFM/CalCard information: Name CFM or CalCard Class Provider Expiration Date Completed by: Print Name Signature Title GAEMP PropremV.lobil ROUNDUN202/NbW.Maori end Map-d Payment LOMBO UPDATE-REVISED V1R24.d— C-- Official Consumer Food Protection Inspection Report 'Q:1� `1�,. Department of Public Health Environmental Health Division 1221 Fulton Street,P.O.Box 11867,Fresno,CA 93775,Phone(559)600-3357 http://www,fcdph.org Email: EnvironmentalHealth@fresnocountyca.gov RnL•4 FACILITY ID: FA10091811 RECORD ID: FOOD10090042 CT: Tract 13.03 ADIEL CORN Time In: 03/19/2024 11:15 am 1639 S ORANGE AVE CMFO CART Time Out: 03/19/2024 12:00 pm FRESNO CA 93702 OWNER: OLIVIA RIVERA (559) 672-9051 Reins ection Date: FOOD Mobile Facility Final Inspection Mobile Food Vendors- Mobile Food Facility(MFF) Permit Expiration Date: 03/31/2025 Sticker Affixed: Yes Balance Due: $0.00 Location Found DOCUMENTS OBTAINED ❑ OP STATEMENT OBTAINED or ❑ Operating: 1639 S ORANGE AVE 0 COMM AUTH Z DRIVERS LIC. N/A Commissary Name: QUEENY'S CATERINt ❑VEHICLE REG 2 LAST SIX VIN: N/A FSC Name: ANGEL LAUREANO Exp. Date Agency: Linen (ppm) Cl: Linen (ppm) Qt: Utensil Sink(ppm)Cl: Utensil Sink(ppm) Qt: Hot Temperature: 140 Cold Temperature: Violations / Not in compliance TEMPERATURE CONTROL: Documentation re uired for all facilities with potentially hazardous food. Type of Food Temp Process/Holding Location 1 WATER BATH 140 0 CORN POT Observed and in Compliance: la. Food safety certification(s) current and available 1b. Adequate knowledge of food safety/allergens 5. Hands clean and properly washed; gloves used properly 6. Adequate handwashing facilities supplied &accessible 7. Proper hot and cold holding temperatures maintained 15. Food obtained from approved source 22. Sewage and wastewater properly disposed 23. No rodents, insects, birds, or animals observed 24. Person in charge (PIC) is present and performs duties 25. Personal cleanliness maintained and hair restraints used 30. Packaged.food storage meets requirements 33. Nonfood contact surfaces clean; cooking equipment is clean 35. Equipment approved, installed, clean, in good repair, with adequate capacity 41. Plumbing in compliance, backflow prevented with approved protection devices Page 1 of 3 44. Premises maintained; personal/cleaning items separate; vermin-proofing adequate; no unused equipment; mop sink meets requirements 51. No imminent health hazard 61a. Drivers license/identification provided 62. Current Commissary Authorization provided 64a. Mobile properly identified with required information on customer side 64b. Mobile identification proper size and in contrasting color 64c. Mobile properly identified on both sides 65c. Joints and seams tight, sealed and easily cleanable 65d. Non-portable equipment integral to primary unit 65f. Gas-fired equipment meets ANSI standards 65g. Electrical equipment meets Underwriters Laboratory standards 65h. No gaps around pipes and/or hoses; sealant smooth and easy to clean 65m. Surfaces of enclosed food preparation area are impervious, smooth and easy to clean 68b. Handwash sink easily accessible 68c. Approved separation or splashguard between hand wash and warewash sinks 79a. Required tanks present and made of proper material(s) 79b. Tanks drain completely 79c. Condition or construction of water system and connections prevents contamination of water, food, prep areas and utensils. 79g. Capacity of potable water tank is sufficient 79k. Capacity of wastewater tank is sufficient 791. Wastewater tank for ice melt present and has sufficient capacity 79m. Wastewater tank has shut-off valve, is emptied and serviced appropriately General Comments: CMFO CART WAS PREVIOUSLY INSPECTED ON 3-12-24. ALL CORRECTIONS FROM THAT INSPECTION ARE COMPLETE. - FOOD COMPARTMENT COVER INSTALLED OVER CORN POT - GROMMET/SEALANT PROVIDED AROUND FLEXIBLE GAS LINE WHERE IT PASSES THROUGH A CUT METAL SURFACE NOTES: CART IS A COMPACT MOBILE FOOD OPERATION (CMFO). HANDWASH SINK DOES NOT NEED HOT WATER. MENU INCLUDES CORN ON THE COB, SHAVED ICE, AND PREPACKAGED FOODS. CONDIMENTS FOR THE CORN MUST BE SHELF-STABLE - PARMESEAN CHEESE OK, MAYO OK, HOT SAUCE OK. PERMIT FEE PAID TODAY-TRANSACTION ID 265576406 HEALTH PERMIT STICKER ISSUED TODAY FA10091811 / FOOD10090042 03/19/2024 Page 2 of 3 NOTICE: REINSPECTION FEES WILL BE CHARGED FOR REINSPECTIONS DUE TO UNCORRECTED VIOLATIONS Received By: ANGEL- OWNER Inspected By: Matt Gore FAI0091811 / FOOD10090042 03/19/2024 Page 3 of 3 Mar COUNTY OF FRESNO 2025 DEPARTMENT OF PUBLIC HEALTH ENVIRONMENTAL HEALTH PERMIT 1221 FULTON STREET/P.O. Box 11867, Fresno CA 93775-1867 559 600-3357 / EnvironmentalHealth@fresnocountyca.gov/ www.fcdph.org PERMIT HOLDER IS RESPONSIBLE FOR THIS PERMIT: Renew on or before expiration date. If permit Holder does not receive notice present this ATTN: ANGEL LAUREANO Permit to the address above on or before the ADIEL CORN expiration date. Late payment penalties are PO BOX 353 assessed at 10% per month or fraction thereof. ORANGE COVE,CA 93646 PERMIT IS NOT TRANSFERABLE &MAY BE REVOKED FOR CAUSE. Permit is void on change of owner. New owner must apply and pay for permit (s) prior to operation or penalties will be assessed. REGULATED FACILITY: ADIEL CORN 1639 S ORANGE AVE FRESNO,CA,93702 Facility ID: FA10091811 Issued: 06/10/2024 OWNER NAME: OLIVIA TRINIDAD OLIVERA Permit To Operate FOOD10090042 Mobile Food Vendors Mobile Food Facility(MFF)CMFO CART Permit Valid From 04/01/2024 To 03/31/2025 • BE ADVISED: Permits are NOT VALID for 1.mobile food facilities,2.mobile food preparation units,3.compact mobile food carts,or 4. push carts prepackaged,until a`Vehicle Permit Approval'sticker is applied to the vehicle by Environmental Health Division staff. Please call 559-600-3357 to make an appointment for an inspection to obtain this sticker prior to operating. Permit Effective from: April 01, 2024 and expires on: March 31, 2025 Permits to operate and fee payments are NON-TRANSFERABLE or refundable. Permits referenced above are valid only for this owner: OLIVIA TRINIDAD OLIVERA THIS FORM MUST BE DISPLAYED CONSPICUOUSLY ON THE PREMISES FRESNO COUNTY PARKS APPLICATION FORM First&Last Name: Dt /t✓�� ��(���' 41 Date: Business Name: I'VGarr' ❑ dba OR ❑ Sole Proprietorship Address: (6 S �✓ Parks Administration: (street) County of Fresno (City) �� (state) (zip) "] Parks/Resources Division Cr t Phone: 2220 Tulare Street, 9th Floor (Day) r` (Night) Fresno,CA93721 FAX: (_) �5� T 3�99Email Address: 2�. Phone:(559)600-3004 (� Mal, aCO�)600 4552 Parks Applying For: Describe location in park(s)where you'd like to set-up: Avocado Lake [;YLost Lake Park J�lChoinumni Park KSkaggs Bridge Park Kearney Park NZPine Flat Recreation Area ALaton-Kingston Park FfkWinton Park Give a description of services/products you'll be selling: Co ✓ , -Eos (C/I0 -�vs ; 0 ems, 60 Q Days and hours of operation: 5��44 e:5y 4AY Confirm that you can supply the following required insurance as stated in the sample Agreement,Section 10: l Commercial General Liability Auto Liability ❑ Workman's Compensation Permit from the County of Fresno Department of Health, Environmental Health Division KA Print Name: r1 LJ(6A- ��n A] Signature: l elf(9'L71S Date: