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HomeMy WebLinkAboutVendor Agreement Ins 1-2 Mixteco.pdf 1 LICENSE AGREEMENT 2 April 16, 2025 THIS LICENSE AGREEMENT ("Agreement") is dated and is between 3 Mixteco Ice Cream 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 Avocado Lake Park WHEREAS, COUNTY owns and/or operates (name of park) 7 3625 N Piedra Rd, Sanger, CA 93657 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 snow cones,corn,chips,tostielotes, PREMISES for the operation of prepackaged snacks,duritos,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 COU NTV 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, 2025_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 may be 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 I 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 Mixteco Ice Cream Steven E. White, Director Angel Laureano Neri Dept. of Public Works and Planning Owner 17 Resources Division Manager 2220 Tulare Street, 6th Floor 1639 S Orange Ave 18 Fresno, CA 93721-2120 Fresno,CA 93646 (559) 600-4078 559-672-9051 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 I 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 Ill 23 24 25 26 27 28 COUNTY OFFRESNO Fresno,California 8 I 1N 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 WhltewhiDalete :2025.04.16 5 By. A-rov/ By 13:59:19-07'00' Title%Wner Steven E. White, Director 6 Department of Public Works and Planning 7 Date: (-A 15 - �/—S APPROVED AS TO LEGAL FORM: 8 Daniel Cederborg, County Counsel Zachary Digitally signed by 9 ry Zachary Adams Date:2025.04.15 By Adams 11:39:27-07'00' 10 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 OF FRESNO Fresno,Califomia 9 Avocado Lake Park N 9SO Speed limit 15 miles per hour J 3625 N Piedra Rd.,Sanger,CA 93657 u �c- Public Restroom Q Avacaoo laka Park .p Public Restroom v� !P� �o P Playground Public Restroom PlaVground Public Restroom Public Restroorn Ernest Lawrence Pavilion C a 4 y r t z Avocado Lake Park rL Q' 2 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 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 OF FRESNO Fresno,California 11 STATE FARM GENERAL INSURANCE COMPANY EX Ac STOCK COMPANY WITH HOME OFFICESINBLOOMINGTON,ILLINOIS DECLARATIONS AMENDED OCT 182024 B-1110 091 IL 6f702.2915 Policy Number 90-EES294-9 Named Insured Policy Period Effective Data Expiration Date M-12-6168-FBSO F Z 12 Months AUG 2 2024 AUG 2 2025 NERI, ANGEL L The oli eriod begins and ends at12:01 am standard time at e�rermses location. DBA MIXTECO ICE CREAM 404 D ST ORANGE COVE CA 93646-2156 Agent and Mailing Address A IANNA ONTIVEROS INS AGCY INC 780 W EL MONTE WAY STE C DINUBA CA 93618-3546 — PHONE: (559) 595-1700 Food Shop Policy Automatic Renewal-Ifthe policy period is shown as 12 months,this policy will be renewed automatically subject-to the premiums,rules and forms in effectfor each succeeding policy period.If this policy is terminated,we will give you and the MDrtgagee/Lienholder written notice in compliance with the policy provisions or as required by law. Entity:Individual Reason for Declarations: Your policy is amended OCT 18 2024 ADDITIONAL INSURED ADDED PREMIUM ADJUSTMENT FORM CMP-4860.1 ADDED Endorsement Premium None Discounts Applied: Renewal Year Years in Business Claim Record Prepared NOV 07 2024 ©Copyright,State Fann Mutual Automobile Insurance Comparry,2008 CMP-40DO Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 009755 290 1 Continued on Reverse Side of Page Page 1 of 8 N 1Y 530 Mal D5 312011(0=10 DECLARATIONS(CONTINUED) Food Shop Policy for NERI ANGEL L Policy Number 90-9ES294-9 SECTION I-PROPERTY SCHEDULE Location Location of Limit of Insurance* Limit of Insurance* Seasonal Number Described Increase- Premises Coverage A- Coverage B- Business Buildings Business Personal Personal Property Property 001 404 D ST No Coverage $ 2,000 25% ORANGE COVE CA 93646-2156 *As of the effective date of this policy,the Limit of Insurance as shown includes any increase in the limit due to Inflation Coverage. SECTION I-INFLATION COVERAGE INDEXES) Gov A-Inflation Coverage Index: N/A Gov B-Consumer Price Index: 312.3 SECTION I-DEDUCTIBLES Basic Deductible $1,000 Special Deductibles: Money and Securities $25D Employee Dishonesty $250 Equipment Breakdown $1,000 Other deductibles may apply-refer to policy. Prepared NOV 07 2024 ©Copyright State Fann Mutual Automobile Insurance Company,2W8 OMP-40DO Includes copyrighted material of Insurance Services Office,Inc.,with its permission. O09755 Continued on Next Page Page 2 of 8 DECLARATIONS(CONTINUED) Food Shop Policy for NERI ANGEL L Policy Number 90-EE-S294-9 SECTION I-EXTENSIONS OF COVERAGE-LIMIT OF INSURANCE EACH DESCRIBED PREMISES The coverages and corresponding limits shown below apply separately to each described premises shown in these Declarations,unless indicated by"See Schedule." If a coverage does not have a corresponding limit shown below, but has'Included"indicated,please refer to that policy provision for an explanation of that coverage. LIMIT OF COVERAGE INSURANCE Accounts Receivable On Premises $10,000 Off Premises $5,000 Arson Reward $5,000 Back-Up Of Sewer Or Drain $15,000 Collapse Included Damage To Non-Owned Buildings From Theft,Burglary Or Robbery Coverage B Limit Debris Removal 25%of covered loss Equipment Breakdown Included Fire Department Service Charge $5,000 Fire Extinguisher Systems Recharge Expense $5,000 Food Contamination Additional Advertising Expenses $3,000 Per Occurrence $10,000 Forgery Or Alteration $10,000 Glass Expenses Included Increased Cost Of Construction And Demolition Costs(applies only when buildings are 10% insured on a replacement cost basis) Money And Securities(Off Premises) $5,000 Money And Securities(On Premises) $10,000 Money Orders And Counterfeit Money $1,000 Prepared NOV 07 2024 ©Copyright State Farm Mutual Automobile Insurance Comparry,2008 OMP-40DO Includes copyrighted material of Insurance Services Nice,Inc.,with its permission. D09756 290 Continued on Reverse Side of Page Page 3 of 8 N DECLARATIONS(CONTINUED) Food Shop Policy for NERI ANGEL L Policy Number 90-gES294-9 Newly Acquired Business Personal Property(applies only if this policy provides $100,000 Coverage B-Business Personal Property) Newly Acquired Or Constructed Buildings(applies only if this policy provides $250,000 Coverage A-Buildings) Ordinance Or Law-Equipment Coverage Included Outdoor Property $5,000 Personal Effects(applies only to those premises provided Coverage B-Business $2,500 Personal Property) Personal Property Off Premises $15,000 Pollutant Clean Up And Removal $10,000 Preservation Of Property 30 Days Property Of Others(applies only to those premises provided Coverage B-Business $2,500 Personal Property) Signs $10,000 Spoilage(applies only to those premises provided Coverage B-Business Personal Property)Expediting Expenses $1,000 On Premises $15,000 Off Premises $5,000 Valuable Papers And Records On Premises $10,000 Off Premises $5,000 SECTION I-EXTENSIONS OF COVERAGE-LIMIT OF INSURANCE-PER POLICY The coverages and corresponding limits shown below are the most we will pay regardless of the number of described premises shown in these Declarations. LIMIT OF COVERAGE INSURANCE Dependent Property- Loss Of Income $5,000 Employee Dishonesty $10,000 Prepared NOV 07 2024 ©Copyright State Farm Mutual Automobile Insurance Company,2008 OMP-4000 Indudes copyrighted material of Insurance Services Office,Inc.,with its permission. 009756 Continued on Next Page Page 4 of 8 DECLARATIONS(CONTINUED) Food Shop Policy for NERI ANGEL L Policy Number 90-ESE-S294-9 Utility Interruption-Loss Of Income $10,000 Loss Of Income And Extra Expense Actual Loss Sustained-12 Months SECTION II-LIABILITY LIMIT OF COVERAGE INSURANCE Coverage L-Business Liability $1,000,000 Coverage M-Medical Expenses(Any One Person) $5 000 Damage To Premises Rented To You $300,000 LIMIT OF AGGREGATE LIMITS INSURANCE Products/Completed Operations Aggregate $2,000,000 General Aggregate $2,000,000 Each paid claim for Liability Coverage reduces the amount of insurance we provide during the applicable annual period.Please refer to Section II-Liability in the Coverage Form and any attached endorsements. Your policy consists of these Declarations,the BUSINESSOWNERS COVERAGE FORM shown below,and any other forms and endorsements that apply,including those shown below as well as those issued subsequent to the issuance of this policy. FORMS AND ENDORSEMENTS CMP-4101 Businessowners Coverage Form CMP-4860.1 *AI Design Person Org CMP-4787 *Waiver of Trans Rgt of Recov CMP-4697 Food Contamination FE-6999.3 Terrorism Insurance Cov Notice CMP-4705.2 Loss of Income&Extra Expense CMP-4710 Employee Dishonesty CMP-4709 Money and Securities CMP-4471 Spoilage Coverage Prepared NOV 07 2024 ©Copyright,State Fann Mutual Automobile Insurance Company,2008 CMP-4000 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. D09757 290 Continued on Reverse Side of Page Page 5 of 8 N DECLARATIONS(CONTINUED) Food Shop Policy for NERI ANGEL L Policy Number 90-gES294-9 CMP-4698 Back-Up of Sewer or Drain CMP-4704.1 Dependent Prop Loss of Income CMP-4703.1 Utility Interruption Loss Incm CMP-4793.1 All State Political Perm Prem CMP-4260.1 Amendatory Endorsement-CA OMP-4261 Amendatory Endorsement CMP-4791.1 Addl Insd State Political Perm CMP-4788.1 Addl Insd Mgrs Lessor of Prem FD-6007 Inland Marine Attach Dec NOTICE:INFORMATION CONCERNING CHANGES IN YOUR POLICY LANGUAGE IS INCLUDED.PLEASE CALL YOUR AGENT IF YOU HAVE ANY QUESTIONS. New Form Attached SCHEDULE OF ADDITIONAL INTERESTS Interest Type: Addl Insured-Section II Interest Type: Addl Insured-Section II Endorsement#: OMP48601 Endorsement#: OMP4787 Loan Number: WA Loan Number: N/A CHOWCHILLA ELEMENTARY SCHOOL CHOWCHILLA ELEMENTARY SCHOOL DISTRICT DISTRICT 355 N 5TH ST 355 N 5TH ST CHOWCHILLA CA 936102410 CHOWCHILLA CA 936102410 Interest Type: Addl Insured-Section II Interest Type: Addl Insured-Section 11 Endorsement#: CMP47931 Endorsement#: CMP48601 Loan Number: N/A Loan Number: WA CITY OF REEDLEY KINGS CANYON UNIFIED SCHOOL 845 G ST DISTRICT REEDLEY CA 936542625 15021ST REEDLEY CA 936543350 Interest Type: Addl Insured-Section 11 Interest Type: Addl Insured-Section II Endorsement#: CMP47911 Endorsement#: CMP48601 Loan Number: WA Loan Number: N/A CITY OF DINUBA SANGER UNIFIED SCHOOL DISTRICT 405 E EL MONTE WAY 1199 COMMERCE WAY DINUBA CA 936181691 SANGER CA 936578726 Prepared NOV 07 2024 ©Copyright State Farm Mutual Automobile Insurance Company,2008 OMP4000 Includes copyrighted material of Insurance Services a ice,Inc.,with its permission. 009757 Continued on Next Page Page 6 of 8 DECLARATIONS(CONTINUED) Food Shop Policy for NERI ANGEL L Policy Number 90-EES294-9 Interest Type: Addl Insured-Section II Interest Type: Addl Insured-Section II Endorsement#: OMP48601 Endorsement#: OMP47881 Loan Number: N/A Loan Number: N/A COUNTY OF FRESNO VISALIA MALL,L.P.BROOKFIELD 2220 TULARE ST FL 6 PROPERTIES RETAIL HOLDING LLC _ FRESNO CA 937212127 BROOKFIELD PROPERTIES RETAIL INC,BROOKFIELD PROPERTY — 2031 S MOONEY BLVD 76241 Interest Type: Addl Insured-Section II Interrest T A 9327nsure Endorsement#. CMP48601 Endorsement#: OMP48601 Insured-Section II Loan Number: N/A Loan Number: N/A VISALIA UNIFIED SCHOOL CITY OF ORANGE COVE DISTRICT (DIANNE FEINSTEIN SKATEPARK 5000 W CYPRESS AVE PARKING LOT(E.PARLIER AVE) VISALIA CA 932778300 633 6TH ST ORANGE COVE CA 936462493 Interest Type: Addl Insured-Section II Interest Type: Addl Insured-Section II Endorsement#: CMP48601 Endorsement#: CMP48601 Loan Number: WA Loan Number: N/A SELMA UNIFIED SCHOOL DISTRICT TULARE COUNTY 3036 THOMPSON AVE 2637 W BURRELL AVE STE 200 SELMA CA 936622433 VISALIA CA 932914506 This policy is issued by the State Farm General Insurance Company. Participating Policy You are entitled to participate in a distribution of the earnings of the company as determined by our Board of Directors in accordance with the Company's Articles of Incorporation,as amended. In Witness Whereof,the State Farm General Insurance Company has caused this policy to be signed by its President and Secretary at Bloomington,Illinois. M-�� - Secretary President Prepared NOV 07 2024 ©Copyright State Farm Mutual Automobile Insurance Company,2008 CMP- 000 Includes copyrighted material of Insurance Services Dffice,Inc.,with its permission. 009758290 Continued on Reverse Side of Page Page 7 of 8 N DECLARATIONS(CONTINUED) Food Shop Policy for NERI ANGEL L Policy Number 90-9ES294-9 IMPORTANT NOTICE: California law requires us to provide you with information for filing complaints with the Slate Insurance Department regarding the coverage and service provided under this policy. Your agent's name and contact information are provided on the front of this document.Another option is to reach out by mail or phone directly to: State Farm'I Executive Customer Service PO Box 2320 Bloomington IL 61702 Phone#1-800-STATEFARM(1-800-782-8332) Department of Insurance complaints should be filed only after you and State Farm or your agent or other company representative have failed to reach a satisfactory agreement on a problem. California Department of Insurance Consumer Services Division 300 South Spring Street Los Angeles,CA 90013 Phone#1-800-927-HELP(4357)or visit www.insurance.ca.gov/01-consumers Prepared NOV 07 2024 ©Copyright.State Farm Mutual Automobile Insurance Company,2008 OMP-4000 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 009758 290 Page 8 of 8 N STATE FARM GENERAL INSURANCE COMPANY A STOCK COMPANY wrrH HOME OFFIOESINBLOOMINGTON,ILLMOIS INLAND MARINE ATTACHING DECLARATIONS B�oomiin Box gioln IL 6 1 702-29 1 5 Policy Number 90-EE-S294-9 Named Insured Polic Period Effective Date Expiration Date M-12-6168-FB60 F Z 12 Montths 9AUG 2 2024 AUG 2 2025 NERI, ANGEL L time atlthe premisestocauaon ends at12:01 am standard DBA MIXTECO ICE CREAM 404 D ST ORANGE COVE CA 93646-2156 ATTACHING INLAND MARINE Automatic Renewal-If the policy period is shown as 12 months,this policy will be renewed automatically subjectto the premiums,rules and forms in effectfor each succeeding policy period.If this policy is terminated,we will give you and the Mortgagee/Lienholder written notice in compliance with the policy provisions or as required by law. Annual Policy Premium $ 22.00 The above Premium Amount is included in the Policy Premium shown on the Declarations. Your policy consists of these Declarations,the INLAND MARINE CONDITIONS shown below,and any other forms and endorsements that apply,including those shown below as well as those issued subsequent to the issuance of this policy. Fomts,Options,and Endorsements FE-8739 Inland Marine Conditions FE-6271 Amendatory Endorsement FE-8745 Inland Marine Computer Prop FE-8759 Miscellaneous Articles Form See Reverse for Schedule Page with Limits Prepared NOV 07 2024 ©Copyright,State Farm Mutual Automobile Insurance Company,200B FD-6007 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 009759 53062682 D5317011(olPd737c) 90-EES294-9 ATTACHING INLAND MARINE SCHEDULE PAGE ATTACHING INLAND MARINE ENDORSEMENT LIMIT OF DEDUCTIBLE ANNUAL NUMBER COVERAGE INSURANCE AMOUNT PREMIUM FE-8745 Inland Marine Computer Prop $ 25,000 S 500 Included Loss of Income and Extra Expense $ 25,000 Included FE-8759 Miscellaneous Articles Form $ 11000 $ 100 5 22.00 PROPERTY:ICE CREAM MOBILE CART/FREEZER,HANDTOOLS OTHER LIMITS AND EXCLUSIONS MAY APPLY-REFER TO YOUR POLICY Prepared NOV 07 2024 ©Copyright State Farm Mutual Automobile Insurance Company,2008 FD-6007 Includes copyrighted material of Insurance Services Dffice,Inc.,with its permission. 009759 sm e2e0 as 312011(ul PiM) 90-EES294-9 009760 553-4370 CA IMPORTANT NOTICE Anti-Fraud Disclosure For your protection California law requires notification of the following disclosure: Any person who knowingly presents false or fraudulent information to obtain or amend insurance coverage or to make a claim for the payment of a loss is guilty of a crime and may be subject to fines and confinement in state _ prison. 553-4370 CA 90-EE-S294.9 009760 90-EE-S294-9 009761 CMP-4860.1 Page 1 of 2 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY CMP4860.1 ADDITIONAL INSURED—DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 90-EES294-9 Named Insured: NERI ANGEL L DBA MIXTECO ICE CREAM 404 D ST ORANGE COVE CA 93646-2156 Name And Address Of Additional Insured Person Or Organization: CHOWCHILLA ELEMENTARY SCHOOL DISTRICT 355 N 5TH ST CHOWCHILLA CA 93610.2410 1. SECTION II — WHO IS AN INSURED of b. If coverage provided to the additional in- SECTION II — LIABILITY is amended to in- sured is required by a contract or agree- clude, as an additional insured, any person or ment, the insurance provided to the organization shown in the Schedule, but only additional insured will not be broader than with respect to liability for "bodily injury", that which you are required by the con- "property damage" or "personal and advertis- tract or agreement to provide for such ad- ing injury"caused, in whole or in part, by: ditional insured; and a. Premises And Ongoing Operations c. If the contract or agreement between you Your acts or omissions or the acts or and the additional insured is governed by omissions of those acting on your behalf: California Civil Code Section 2782 or 2782.05, the insurance provided to the (1) In connection with your premises;or additional insured is the lesser of that (2) In the performance of your ongoing which: operations; or (1) Is allowed for the satisfaction of a de- b. Products-Completed Operations fense or indemnity obligation by Cali- "Your work" performed for that additional fornia Civil Code Section 2782 or insured and included in the "products- 2782.05 for your sole liability;or completed operations hazard". (2) You are required by contract or However, Paragraph 1.above is subject to the agreement to provide for such addi- following: tional insured. a. The insurance afforded to the additional We have no duty to defend or indemnify the insured only applies to the extent permit- additional insured under this endorsement un- ted by law; til a claim or"suit'is tendered to us. O,Copyright,State Farm Mutual Automobile Insurance Company,2013 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. CONTINUED 90-EES294-9 009761 CMP-4860.1 Page 2 of 2 2. Any insurance provided to the additional in- (3) The nature and location of any injury sured shall only apply with respect to a claim or damage arising out of the "occur- made or a "suit" brought for damages for rence"or offense; which you are provided coverage. b. Tender the defense and indemnity of any This endorsement shall not increase the ap- claim or"suit" to h v i and to all other nsur- plicable Limits Of Insurance shown in the ers who may have insurance potentially Declarations. available to the additional insured, and 3. With respect to the insurance afforded to the additional insured, the following is added to c. Agree to make available any other insur- SECTION II—LIMITS OF INSURANCE: ance the additional insured has for de- If coverage provided to the additional insured fense or damages for which we would is required by contract or agreement,the most provide coverage under SECTION II we will pay on behalf of the additional insured LIABILITY. will be the lesser of the amount of insurance: 5. With respect to the insurance afforded the ad- a. Required by the contract or agreement, or ditional insured, the following replaces SEC- b. Available under the applicable Limits Of TION II — LIABILITY of Paragraph 7. Other Insurance shown in the Declarations. Insurance of SECTION I AND SECTION II— COMMON POLICY CONDITIONS: This endorsement shall not increase the ap- plicable Limits Of Insurance shown in the a. This insurance is primary to and will not Declarations. seek contribution from any other insur- ance4. With respect to the insurance afforded to the available to the additional insured, additional insured, the following is added to provided that the additional insured - Paragraph 3. Duties In The Event Of Occur- rence,Offense,Claim Or Suit of SECTION II ance. —GENERAL CONDITIONS: b. Regardless of any agreement between The additional insured must: you and the additional insured, this insur- a. See to it that we are notified as soon as ance is excess over any other insurance practicable of an "occurrence" or an of- whether primary, excess, contingent or on fense which may result in a claim. To the any other basis for which the additional in- extent possible, notice should include: sured has been added as an additional in- (1) How, when and where the "occur- sured on other policies. rence"or offense took place; There will be no refund of premium in the event (2) The names and addresses of any in- this endorsement is cancelled. jured persons and witnesses; and All other policy provisions apply. CMP-4860.1 ©,Copyright,State Farm Mutual Automobile Insurance Company,2013 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. SO-EES294-9 009762 CMP-4860.1 Page 1 of THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CMP-4860.1 ADDITIONAL INSURED—DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 90-EES294-9 — Named Insured: NERI ANGEL L DBA'MIXTECO ICE CREAM 404 D ST ORANGE COVE CA 93646.2156 Name And Address Of Additional Insured Person Or Organization: CHOWCHILLA ELEMENTARY SCHOOL DISTRICT 355 N 5TH ST CHOWCHILLA CA 93610-2410 1. SECTION 11 — WHO IS AN INSURED of b. If coverage provided to the additional in- SECTION II — LIABILITY is amended to in- sured is required by a contract or agree- clude, as an additional insured, any person or ment, the insurance provided to the organization shown in the Schedule, but only additional insured will not be broader than with respect to liability for "bodily injury", that which you are required by the con- "property damage" or "personal and advertis- tract or agreement to provide for such ad- ing injury"caused, in whole or in part, by: ditional insured; and a. Premises And Ongoing Operations c. If the contract or agreement between you Your acts or omissions or the acts or and the additional insured is governed by omissions of those acting on your behalf: California Civil Code Section 2782 or 2782.05, the insurance provided to the (1) In connection with your premises; or additional insured is the lesser of that (2) In the performance of your ongoing which: operations; or (1) Is allowed for the satisfaction of a de- b. Products-Completed Operations fense or indemnity obligation by Cali- "Your work" performed for that additional fornia Civil Code Section 2782 or insured and included in the "products- 2782.05 for your sale liability;or completed operations hazard". (2) You are required by contract or However, Paragraph 1.above is subject to the agreement to provide for such addi- following: tional insured. a. The insurance afforded to the additional We have no duty to defend or indemnify the insured only applies to the extent permit- additional insured under this endorsement un- ted by law; til a claim or"suit'is tendered to us. O,Copyright,State Farm Mutual Automobile Insurance Company,2013 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. CONTINUED 90-EE-S294-9 009762 CMP-4860.1 Page 2 of 2 2. Any insurance provided to the additional in- (3) The nature and location of any injury sured shall only apply with respect to a claim or damage arising out of the "occur- made or a "suit" brought for damages for rence"or offense; which you are provided coverage. b. Tender the defense and indemnity any This endorsement shall not increase the ap- claim or"suit" to h v i and to all other nsur- plicable Limits Of Insurance shown in the ers who may have insurance potentially Declarations. available to the additional insured; and 3. With respect to the insurance afforded to the additional Insured, the following is added to c. Agree to make available any other insur- SECTION II—LIMITS OF INSURANCE: ance the additional insured has for de- If coverage provided to the additional insured fense or damages for which we would is required by contract or agreement,the most provide coverage under SECTION II we will pay on behalf of the additional insured LIABILITY. will be the lesser of the amount of insurance: 5. With respect to the insurance afforded the ad- a. Required by the contract or agreement;or ditional insured, the following replaces SEC- b. Available under the applicable Limits Of TION II — LIABILITY of Paragraph 7. Other Insurance shown in the Declarations. Insurance of SECTION I AND SECTION II— COMMON POLICY CONDITIONS: This endorsement shall not increase the ap- plicable Limits Of Insurance shown in the a. This insurance is primary to and will not Declarations. seek contribution from any other insur- ance4. With respect to the insurance afforded to the available to the additional insured, is a additional insured, the following is added to provided that the additional insured Paragraph 3. Duties In The Event Of Occur- named insured under such other insur- rence,Offense, Claim Or Suit of SECTION II ance. —GENERAL CONDITIONS: b. Regardless of any agreement between The additional insured must: you and the additional insured, this insur- a. See to it that we are notified as soon as ance is excess over any other insurance practicable of an "occurrence" or an of- whether primary, excess, contingent or on fense which may result in a claim. To the any other basis for which the additional in- extent possible, notice should include: sured has been added as an additional in- (1) How, when and where the "occur- sured on other policies. rence"or offense took place; There will be no refund of premium in the event (2) The names and addresses of any in- this endorsement is cancelled. jured persons and witnesses; and All other policy provisions apply. CMP-4860.1 ©,Copyright,State Farm Mutual Automobile Insurance Company,2013 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. SO-EES294-9 009763 CMP-4787 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ IT CAREFULLY CMP4787 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 90-EES294-9 Named Insured: NERI ANGEL L DBA MIXTECO ICE CREAM 404 D ST ORANGE COVE CA 93646-2156 Name And Address Of Person Or Organization: CHOWCHILLA ELEMENTARY SCHOOL DISTRICT 355 N 5TH ST CHOWCHILLA CA 93610-2410 The following is added to Paragraph 10.b. of SECTION I AND SECTION II — COMMON POLICY CONDITIONS: We waive any right of recovery we may have against the person or organization shown in the Schedule because of payments we make for injury or damage arising out of: a. Your ongoing operations; or b. "Your work" done under contract with that person or organization and included in the "products- completed operations hazard". This waiver applies only to the person or organization shown in the Schedule. All other policy provisions apply. CMP-4787 O,Copyright,State Farm Mutual Automobile Insurance Company,2008 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 90-EE-S294.9 009763 90-EES294-9 009764 CMP-4787 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY CMP4787 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 90-EES294-9 Named Insured: NERI ANGEL L DBA'MIXTECO ICE CREAM 404 D ST ORANGE COVE CA 93646-2156 Name And Address Of Person Or Organization: CHOWCHILLA ELEMENTARY SCHOOL DISTRICT 355 N 5TH ST CHOWCHILLA CA 93610-2410 The following is added to Paragraph 10.b. of SECTION I AND SECTION II — COMMON POLICY CONDITIONS: We waive any right of recovery we may have against the person or organization shown in the Schedule because of payments we make for injury or damage arising out of: a. Your ongoing operations; or b. "Your work" done under contract with that person or organization and included in the "products- completed operations hazard". This waiver applies only to the person or organization shown in the Schedule. All other policy provisions apply. CMP-4787 O,Copyright,State Farm Mutual Automobile Insurance Company,2008 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 90-EE-8294.9 009764 Exh L'6�- ,h DATE: Angel Laureano Owner Mixteco Ice Cream 1639 S Orange Fresno, CA 93702 559-972-9051 To County of Fresno Parks: I, Angel Laureano, am the owner of Mixteco Ice Cream, 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, Y Pngel Laureano L�Xk c, h Date: Angel Laureano Owner Mixteco Ice Cream 1639 S Orange Fresno, CA 93702 559-672-9051 To County of Fresno Parks: I,Angel Laureano, owner of Mixteco Ice Cream, 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, Ahgel Laureano C MOBILE MENU/CALCARD 2025 Bu mess Name Date Business Address FA Busine Owner Name FOOD Business Owner T phone Commissary Name Commissary Address 0 List complete MENU that you will be serving (do not list prices): See attached menu ❑ 1 b� J — V © List all EMPLOYEES and CFM/CalCard information: Name CFM or CalCard Class Provider Expiration Date Completed by: Print Name Signature Title G:EMPoad P.,,r WA ilaROUNDUP 25V.10We Menuend Map ar Pay—t COMBO UPDATE-REVISED 2325.dm ,_c-�L, Official Consumer Food Protection Inspection Report t 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: Environmental Health@fresnocountyca.gov FACILITY ID: FA00285848 RECORD ID: FOOD10091619 CT: Tract 13.03 MIXTECO ICE CREAM Time In: 03/19/2025 8:41 am 1639 S ORANGE AVE LIC # 341151-3 Time Out: 03/19/2025 9:56 am FRESNO CA 93702 OWNER: ANGEL LAUREANO (559) 672-9051 Reins ection Date: FOOD Mobile Facility Routine Inspection 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 121 DRIVERS LIC. N/A Commissary Name: ❑ VEHICLE REG ❑ LAST SIX VIN: FSC Name: Exp. Date Agency: Linen (ppm) Cl: Linen (ppm) Qt: Utensil Sink(ppm) Cl: Utensil Sink(ppm) Qt: Hot Temperature: 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 backfow 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: 1) BY NEXT NEAR- PROVIDE P-TRAP FOR THE HAND SINK WASTE LINE. PARA EL PROXIMO ANO - OBTIENE UNA P-TRAP PARA LA PLOMBERIA DEL LA AGUA RESIDUO DEL LAVAMANOS. 2)ALSO, BY NEXT YEAR PROVIDE APPROVED WASTELINE (PVC) FOR HAND SINK WASTELINE GOING TO WASTE WATER TANK. TAMBIEN PARA EL PROXIMO ANO - OBTIENE UNA PIPA APROBADA PARA LA AGUA RESIDUO DEL LAVAMANOS QUE VA AL TANQUE DEL AGUA DESECHABLE. 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. 75c. LPG tanks installed properly Violation: All liquified petroleum equipment shall be installed to meet applicable fire authority standards and shall be approved by the fire authority. [114323(d)] Comments: PROVIDE VENTILATION SCREENING AT THE LOWER(OR FLOOR) PROPANE COMPARTMENT. Remedy: Install liquified petroleum equipment in an approved manner. Page 1 of 2 TEMPERATURE CONTROL: Documentation required for all facilities with potentially hazardous food. Type of Food Temp Process/Holding Location 1 AMBIENT 135 O 1 2 COMPARTMENT HOT UNITS Observed and in Compliance: la. Food safety certification(s) current and available 6. Adequate handwashing facilities supplied &accessible 7. Proper hot and cold holding temperatures maintained 21. Hot and cold water available 22. Sewage and wastewater properly disposed 23. No rodents, insects, birds, or animals observed 33. Nonfood contact surfaces clean; cooking equipment is clean 34. Warewashing facilities installed, maintained, and used appropriately; test strips available 49. Permit current and posted 51. No imminent health hazard 791. Wastewater tank for ice melt present and has sufficient capacity General Comments: ROUTINE INSPECTION OPERATOR HAS VALID FOOD MANAGER CERTIFICATION. OPERATOR STATED THAT WHEN CMFO IS UTILIZED,THE MFPU IS NOT AND WHEN THE MFPU IS UTILIZED THE CMFO IS NOT. YELLOW STICKER ISSUED TODAY. NOTICE: REINSPECTION FEES WILL BE CHARGED FOR REINSPECTIONS DUE TO UNCORRECTED VIOLATIONS Received By: ANGEL- OWNER/OPERATOR Inspected By: Hector Sandoval FA00285848/ FOOD10091619 03/19/2025 Page 2 of 2