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HomeMy WebLinkAboutVendor Agreement Ins 1-2 Adiel Corn.pdf 1 LICENSE AGREEMENT 2 April 16, 2025 THIS LICENSE AGREEMENT ("Agreement") is dated and is between 3 Adiel Corn ro r sole proprietor(name of contractor), a p p (type of entity) 4 ("LICENSEE"), and the County of Fresno, a political subdivision of the State of California 5 ("COUNTY") (collectively, "Parties"). 6 Laton-Kingston Park WHEREAS, COUNTY owns and/or operates (name of park) 7 20055 Fowler Ave, Laton, CA 93242 located at (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,tostieloles,chips,snow cones, PREMISES for the operation of prepackaged duritos,pupitos,and sodas 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 Exhibit "A". LICENSEE shall not solicit customers by any means 28 COUNTY OF FRESNO Fresno,California 1 1 including signs, handouts or amplified sounds outside of the designated location(s). 2 LICENSEE shall not affix signs or banners on trees, bushes or County owned structures. Said 3 location(s) may be changed upon mutual written agreement between the Parties. The Service 4 facilities, and all ancillary equipment, shall be removed at the end of each day of operation. No 5 equipment shall be left at the PREMISES overnight. LICENSEE'S setup shall not interfere with 6 pedestrian traffic. Ample travel ways shall be maintained at all times by LICENSEE. 7 3. TERM 8 The term of this Agreement shall be for 9 months, commencing 9 April 16, 202J and terminating December 31, 2025 unless terminated earlier in the 10 manner specified below in paragraph 4 "Termination". Upon expiration of said term as 11 established above, this Agreement shall not automatically renew and a new license application 12 will need to be submitted. 13 4. TERMINATION: 14 A. Breach of Contract-The COUNTY may immediately suspend or terminate this 15 Agreement in whole or in part, upon the determination by COUNTY that there 16 is on the part of the LICENSEE: 17 1) Improperly performed service; 18 2) A failure to comply with any terms of this Agreement; or 19 3) A substantially incorrect or incomplete report or false information 20 submitted to the COUNTY. 21 In no event shall any receipt of any funds by the COUNTY constitute a waiver by the COUNTY 22 of any breach of this Agreement or any default which may then exist on the part of the 23 LICENSEE with regard to any additional funds payable to COUNTY in connection with this 24 Agreement. Neither shall such payment impair or prejudice any remedy available to the 25 COUNTY with respect to the breach or default for any additional funds owed by LICENSEE to 26 COUNTY. 27 In the event of breach of this Agreement by LICENSEE, COUNTY may immediately terminate 28 this Agreement and LICENSEE will not be eligible for future agreements with the COUNTY for COUNTY OF FRESNO Fresno,California 2 1 Services. 2 B. Without Cause - Under circumstances other than those set forth above, this 3 Agreement may be terminated by either the COUNTY or LICENSEE upon the 4 giving of fifteen (15) days advance written notice of an intention to terminate to the 5 other party. 6 5. COMPENSATION: In consideration for granting this non-exclusive Agreement, 7 LICENSEE shall pay to COUNTY the sum of ten percent (10%) of the gross daily sales by the 8 5th of each month for the use of the PREMISES. If payment is not made by the 7th of each 9 month, a 10% late penalty charge will be due and payable with said payment. If payment is not 10 made within two (2) weeks of the first of each month, this Agreement may be terminated 11 immediately, and the LICENSEE will not be eligible to continue to offer SERVICES within the 12 PREMISES. Payment shall be made to the County of Fresno, Department of Public Works and 13 Planning, ATTN: Resources Manager—2220 Tulare Street, 6th Floor, Fresno, CA 93721-2120. 14 6. DAMAGE DEPOSIT: Upon execution of Agreement, the LICENSEE shall provide 15 a damage deposit of Five Hundred Dollars ($500) to the COUNTY. The damage deposit is 16 refundable, provided however, such deposit shall not be refunded to the extent that the 17 COUNTY incurs costs or expenses related to the LICENSEE's performance of Service. 18 7. INDEPENDENT CONTRACTOR: In performance of the work, duties and 19 obligations assumed by LICENSEE under this Agreement, it is mutually understood and 20 agreed that LICENSEE, including any and all of the LICENSEE'S officers, agents, and 21 employees will at all times be acting and performing as an independent contractor, and shall 22 act in an independent capacity and not as an officer, agent, servant, employee,joint venturer, 23 partner, or associate of the COUNTY. Furthermore, COUNTY shall have no right to control or 24 supervise or direct the manner or method by which LICENSEE shall perform its work and 25 function. However, COUNTY shall retain the right to administer this Agreement so as to verify 26 that LICENSEE is performing its obligations in accordance with the terms and conditions 27 thereof. LICENSEE and COUNTY shall comply with all applicable provisions of law and the 28 rules and regulations, if any, of governmental authorities having jurisdiction over matters the COUNTY OF FRESNO Fresno,California 3 1 subject thereof. 2 Because of its status as an independent contractor, LICENSEE shall have absolutely 3 no right to employment rights and benefits available to COUNTY employees. LICENSEE shall 4 be solely liable and responsible for providing to, or on behalf of, its employees all legally 5 required employee benefits. In addition, LICENSEE shall be solely responsible and save 6 COUNTY harmless from all matters relating to payment of LICENSEE'S employees, including 7 compliance with Social Security withholding and all other regulations governing such matters. 8 It is acknowledged that during the term of this Agreement, LICENSEE may be providing 9 services to others unrelated to the COUNTY or to this Agreement. 10 8. MODIFICATION: Any matters of this Agreement maybe modified from time to 11 time by the written consent of all the Parties without, in any way, affecting the remainder. 12 9. NON-ASSIGNMENT: Neither party shall assign, transfer or sub-contract this 13 Agreement or its respective rights or duties under this Agreement without the prior written 14 consent of the other party. 15 10. INDEMNITY AND DEFENSE: LICENSEE shall indemnify and hold harmless and 16 defend the COUNTY (including its officers, agents, employees, and volunteers) against all 17 claims, demands, injuries, damages, costs, expenses (including attorney fees and costs), fines, 18 penalties, and liabilities of any kind to the COUNTY, the LICENSEE, or any third party that 19 arise from or relate to the performance or failure to perform by the LICENSEE (or any of its 20 officers, agents, sublicensees, or employees) under this Agreement. The COUNTY may 21 conduct or participate in its own defense without affecting the LICENSEE's obligation to 22 indemnify and hold harmless or defend the County. This section survives the termination of this 23 Agreement. 24 11. INSURANCE: The LICENSEE shall comply with all the insurance requirements in 25 Exhibit B to this Agreement. 26 12. PERMITS: LICENSEE shall provide to the foregoing address a copy of any and 27 all permits required by the local governing authority(ies), such as a business license required 28 by the local applicable authority, and a valid Permit To Operate ("Permit") issued by the County COUNTY OF FRESNO Fresno,California 4 1 of Fresno, Department of Community Health, Environmental Health Division not later than 2 fourteen (14) days following the beginning of the Term of this Agreement. LICENSEE 3 understands that said Permit must be obtained on an annual basis and LICENSEE shall 4 provide a copy of any new annual Permit to the aforementioned address within fourteen (14) 5 days of obtaining the Permit. LICENSEE understands that Permits are not transferable or 6 refundable and said Permits become void upon change of ownership. LICENSEE also 7 understands that any new owner(s) and/or operator(s), if an assignment is approved by 8 COUNTY in writing, as required in Section 9 above, must obtain a new Permit in his/her/its own 9 name prior to beginning operation. 10 13. AUDITS AND INSPECTIONS: The LICENSEE shall at any time during business 11 hours, and as often as the COUNTY may deem necessary, make available to the COUNTY for 12 examination all of its records and data with respect to the matters covered by this Agreement. 13 The LICENSEE shall, upon request by the COUNTY, allow the COUNTY to audit and inspect 14 all of such records and data necessary to ensure LICENSEE'S compliance with the terms of 15 this Agreement. 16 14. LITTER AND CLEANUP: LICENSEE shall provide adequate trash disposal units 17 adjacent to the area being utilized and shall be responsible for trash removal and area cleanup, 18 including raking or wet mopping on an as needed basis, but no less often than daily. 19 LICENSEE shall, at the end of each day, inspect the park for litter derived from the sales of his 20 or her Services and remove such litter. LICENSEE shall prevent staining of any grass, cement 21 walkway or asphalt parking area by ensuring that no residue from the unit or food preparation 22 will drip on the grass, concrete or asphalt. Trash containers are to be removed nightly. 23 15. SPECIFICATIONS: LICENSEE shall only sell products or services from mobile 24 unit(s). No general merchandise shall be sold other than those items specifically approved by 25 COUNTY as listed in Exhibit C. No products with glass containers will be allowed to be sold. 26 LICENSEE shall comply with all of the following: 27 A. The California Retail Food Code (Part 7 of Division 104 of the California Health 28 and Safety Code, commencing with Section 113700, hereinafter"CRFC") and regulations COUNTY OF FRESNO Fresno,California 5 1 promulgated thereunder, including but not limited to any future laws and regulations 2 enacted/promulgated to replace or supplement CRFC; and, 3 B. All County of Fresno Ordinances, including all regulations, policies and 4 requirements of the County of Fresno's Department of Community Health; and, 5 C. All health guidance and regulations issued by the State of California and the 6 Fresno County Department of Public Health; and, 7 D. Any other laws, regulations or ordinances as they relate to mobile/portable food 8 concession units. 9 16. UTILITIES AND DISPOSAL: All mobile units operated by the LICENSEE must be 10 self-contained. Electrical power, potable water and sewage disposal is not available. 11 17. DAYS OF OPERATION: LICENSEE may provide Service seven (7) days per 12 week during standard park operational hours, except on days when the PREMISES are closed 13 by the COUNTY or are rented by the COUNTY, in their entirety and on an exclusive basis, to 14 another person or entity for the purpose of hosting or conducting a private or special event. 15 18. GOVERNING LAW: Venue for any action arising out of or relating to this 16 Agreement shall only be in Fresno County, California. The rights and obligations of the Parties 17 and all interpretation and performance of this Agreement shall be governed in all respects by 18 the laws of the State of California. 19 19. POSSESSORY INTEREST TAX: The Parties acknowledge that California 20 Revenue & Taxation Code § 107.6 provides, in relevant part, the following: "(a) The state or 21 any local public entity of government, when entering into a written contract with a private party 22 whereby a possessory interest subject to property taxation may be created, shall include, or 23 cause to be included, in that contract, a statement that the property interest may be subject to 24 property taxation if created, and that the party in whom the possessory interest is vested may 25 be subject to the payment of property taxes levied on the interest." Accordingly, although the 26 COUNTY does not grant a possessory interest under this License, the Parties agree that the 27 COUNTY is a 'local public entity of government', and that LICENSEE is a "private party", 28 respectively, within the meaning of California Revenue & Taxation Code §107.6(a), and that COUNTY OF FRESNO Fresno,California 6 1 this License (to the extent that it may be necessary under California Revenue & Taxation Code 2 §107.6(a) for the Parties to acknowledge and agree herein with respect to this License) is a 3 "contract,"which may create a possessory interest that may be subject to property taxation 4 pursuant to California Revenue & Taxation Code §107.6(a). In this regard, under this License, 5 LICENSEE acknowledges and agrees that (i) the property interest that may be created by this 6 License may be subject to property taxation, and (ii) LICENSEE (i.e., the party in whom the 7 possessory interest, if any, is vested) shall, at its sole cost and expense, be subject to the 8 direct payment of property taxes levied on such interest, and shall directly pay any and all 9 property taxes levied on such interest, and any interest, penalties, or charges thereon for 10 LICENSEE'S late payment of, or failure to pay such amounts when they are due and payable. 11 20. NOTICES: Any and all notices between either party under the terms of this 12 Agreement or by law shall be in writing and shall be deemed to be duly given if served when 13 personally delivered or deposited into the United States mail, with postage prepaid, registered, 14 and addressed to the respective addresses stated as follows: 15 COUNTY LICENSEE 16 County of Fresno Olivia Trinidad Olivera Steven E. White, Director Owner Dept. of Public Works and Planning Adiel Corn 17 Resources Division Manager 2220 Tulare Street, 6th Floor 1639 S Orange 18 Fresno, CA 93721-2120 Fresno,CA 93702 (559) 600-4078 559-859-3428 19 parks@fresnocountyca.gov angellaureano502@gmail.com 20 21 21. ELECTRONIC SIGNATURES: The Parties agree that this Agreement may be 22 executed by electronic signature as provided in this section. 23 (A) An "electronic signature" means any symbol or process intended by an individual 24 signing this Agreement to represent their signature, including but not limited to (1) a digital 25 signature; (2) a faxed version of an original handwritten signature; or(3) an electronically 26 scanned and transmitted (for example by PDF document) of a handwritten signature. 27 (B) Each electronic signature affixed or attached to this Agreement (1) is deemed 28 equivalent to a valid original handwritten signature of the person signing this Agreement for all COUNTY OF FRESNO Fresno,California 7 1 purposes, including but not limited to evidentiary proof in any administrative or judicial 2 proceeding, and (2) has the same force and effect as the valid original handwritten signature of 3 that person. 4 (C)The provisions of this section satisfy the requirements of Civil Code section 1633.5, 5 subdivision (b), in the Uniform Electronic Transaction Act(Civil Code, Division 3, Part 2, Title 6 2.5, beginning with section 1633.1). 7 (D) Each party using a digital signature represents that it has undertaken and satisfied 8 the requirements of Government Code section 16.5, subdivision (a), paragraphs (1)through 9 (5), and agrees that each other party may rely upon that representation. 10 (E)This Agreement is not conditioned upon the parties conducting the transactions 11 under it by electronic means and either party may sign this Agreement with an original 12 handwritten signature. 13 22. ENTIRE AGREEMENT: This Agreement constitutes the entire agreement 14 between the LICENSEE and COUNTY with respect to the subject matter hereof and 15 supersedes all previous Agreement negotiations, proposals, commitments, writings, 16 advertisements, publications, and understandings of any nature whatsoever unless expressly 17 included in this Agreement. 18 19 20 21 22 23 24 25 26 27 28 COUNTY OF FRESNO Fresno,California 8 1 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 +1 Steve White White 5 By % 5.04.16 � l I U�` I'� \ems V V Date:49-07''00' c 1C cam'/— By 13:59:49-0T00' Title Owner Steven E. White, Director 6 Department of Public Works and Planning 7 _ Date: APPROVED AS TO LEGAL FORM: 8 Daniel Cederborg, County Counsel Zachar Digitally signed by 9 y Zachary Adams y Adams Date:2025.04.15 10 B 11:35:02-07'00' Deputy 11 FOR ACCOUNTING USE ONLY: 12 Budget Unit No.: 7910 Fund No.: 0001 13 Account No.: 3400 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 COUNTY OFFRESNO Fresno,California 9 ��Nta�rtoa aAVJaIMoj anyt1JEL any C� � a a C/] m b D m WJ N Q • r--� E o Iw/1 •E j L w r > o Q Y O ) 0LL 0 Q � O Y (O a c 0 rn c Y c O J 7� 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. 15 (D) Employer's Liability. Employer's liability insurance with limits of not less than One 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 23 obtained and is in full force; (2) the County, its officers, agents, employees, and 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 16 limits, or both. To that end, the Licensee shall deliver, or cause its broker or producer to 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 OF FRESNO Fresno,California 11 .ACV�►� --� CERTIFICATE OF LIABILITY INSURANCE °Ao�1V2o25"' 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 policy0es)must have ADDITIONAL INSURED provisions or be endorsed.IfSUBROGATION IS WAIVED,subjectto 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 ofsueh endorsement(s). PRODUCER CONTACT.' NAME: Marla C Lopez Maria C Lopez(Farmers Insurance 9545EX) PHONE Fax 407 S Clovis Ave.#105 (A/c,No,En):559-252-2345 (A/c,No):559-558-8931 Fresno Ca.93727 E-MAIL ADDRESS: mlopez2@farmersagent.com INSURERS)AFFORDING COVERAGE NAIL# INSURED INSURERA: Scottsdale Insurance Company 41297 INSURER B: Olivia Trinidad Olivera DBA-AdIQI Corn INSURERC; 404 D St. iNSURERD: Orange Cove Ca.93646 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER THIS IS TO CERTIFY THATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAME ABOVE FOR THE POLICY PERIOD INDICATED.NbTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECTTO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BYTHE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALLTH E TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPEOFINSURANCE ADDTL SUBR POLICYEFF POLICYEXP LTR .. INSD WVD POUCYNUMBER LIMITS. ' (MM/DD/YYYY) (MM/DD/YYYY)' COMM ERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES(Ea Occurrence) $ 100,000 M ED EXP(Anyone person, $ 5,000 A Y Y CPS4065074 03/20/2025 03/20/2026 PERSONAL&ADV INJURY $ 1,000,000 GEN'L'AGGREGATELIMITAPPLIESPER: GENERAL AGGREGATE $ 2,000,000 POUCY ❑PROJECT LOC PRODUCTS-COMP/OPAGG $ 1,000,0.00 ' OTHER: $ AUTOMOBILELIABILITY COMBINED SINGLE LIMIT $ ANYAUTO (Ea accident) BODILY INJURY(Per person) $ OWNEDAUTOS SCHEDULED ONLY AUTOS BODILY INJURY(Per accident)$ HIREDAUTOS NON-OWNED ONLY AUTOS ONLY PROPERTY DAMAGE(Peraccident) $ UMBRELLAUAB OCCUR %A.CCIW $EXCESS UAB CLAIMS-MADE $DED RETENTION$ WORKERS COMPENSATIONANDEMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/ Y/N .EXECUTIVE OFFICER/MEMBER N/A EXCLUDED?(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE Ifyes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY.LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORO 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 oun o resno SHOULDANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Fres Tulare DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCO ANCE WITH THE POLICY PROVISIONS.. reSr10.Ca..93721 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION.All Rights Reserved 1"I7R4 t t t S The ACORD name and loan are registered marks of ACORD Date: 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, C Olivia Olivera Trinidad kf� bL DATE: 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, �� l��`fie•_�r I n I��4° Olivia Olivera Trinidad txhL " - C, MOBILE MENU/CALCARD 2025 Business Name Date Ad(ej Ozf Business Address FA Busin ss 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 ❑ OIL- o f � - (C 1` jcc cC © List all EMPLOYEES and CFM/CalCard information: Name CFM or CalCard Class Provider Expiration Date Completed by: Print Name Signature Title G:THT.d R.g.m1M.WI.VtCUNDUP1 25Vdnb4.Menu and Map aM Paymanl COMBO UPDATE-REVISED 2325.d— Official Consumer Food Protection Inspection Report Department of Public Health Environmental Health Division 1221 Fulton Street,P.O. Box 11867, Fresno,CA 93775, Phone(559)600-3357 ��5 J http://www.fcdph.org Email: EnvironmentalHealth@fresnocountyca.gov `FRGi FACILITY ID: FAI0091811 RECORD ID: FOOD10090042 CT: Tract 13.03 ADIEL CORN Time In: 03/18/2025 1:18 pm 1639 S ORANGE AVE CMFO CART Time Out: 03/18/2025 1:48 pm FRESNO CA 93702 OWNER: OLIVIA TRINIDAD OLIVERA Reins ection Date: FOOD Mobile Facility Routine Reinspection Mobile Food Vendors - Compact Mobile Food Operation Permit Expiration Date: 03/31/2026 Sticker Affixed: Yes Balance Due: $0.00 Location Found DOCUMENTS OBTAINED ❑ OP STATEMENT OBTAINED or ❑ Operating: 1639 S ORANGE AVE 0 COMM AUTH 0 DRIVERS LIC. N/A Commissary Name: NINIS TAQUERIA ❑ VEHICLE REG ❑ LAST SIX VIN: FSC Name: OLIVIA OLIVERA Exp. Date 04/27/2029 Agency: RESPONSIBLE TRAININC Linen (ppm) Cl: 100 Linen (ppm) Qt: Utensil Sink(ppm) Cl: Utensil Sink(ppm) Qt: Hot Temperature: 180 Cold Temperature: Violations / Not in compliance 41. Plumbing in compliance, backflow prevented with approved protection devices Violation: The potable water supply shall be protected with a backflow or back siphonage protection device, as required by applicable plumbing codes. All plumbing and plumbing fixtures shall be installed in compliance with local plumbing ordinances, shall be maintained so as to prevent any contamination, and shall be kept clean, fully operative, and in good repair. (114171, 114189.1, 114190, 114193, 114192, 114192.1, 114193.1, 114195, 114199) Comments: Notes on file about handwashing sink required to have a p trap and non-flexible plumbing (mobile plan check requirement) Remedy: Repair plumbing leak(s) in an approved manner and clean thoroughly. Ensure indirect waste receptors are readily accessible for cleaning &servicing, and waste piping has an appropriate air gap. TEMPERATURE CONTROL: Documentation required for all facilities with potentially hazardous food. Type of Food Temp Process/Holding Location 1 Observed and in Compliance: 1a. Food safety certification(s) current and available 1b. Adequate knowledge of food safety/allergens 2. Communicable disease reporting, restriction &exclusion requirements followed 6. Adequate handwashing facilities supplied &accessible 7. Proper hot and cold holding temperatures maintained Page 1 of 2 33. Nonfood contact surfaces clean; cooking equipment is clean 61a. Drivers license/identification provided General Comments: Permit issued- See notes on what mobile plan check inspectors are requiring for sink and potable water tank to be completed within 1 year. NOTICE: REINSPECTION FEES WILL BE CHARGED FOR REINSPECTIONS DUE TO UNCORRECTED VIOLATIONS Received By: OLIVIA TRINIDAD, OWNER Inspected By: Graciela Bravo FAI0091811 / FOOD10090042 03/18/2025 Page 2 of 2