STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION DIVISION OF HOTELS AND RESTAURANTS DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION, Petitioner, vs. CHURCH'S CHICKEN License No. 2610901 Respondent. License Type 2010 / Case No. 2003096570 ADMINISTRATIVE COMPLAINT The DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION, DIVISION OF HOTELS AND RESTAURANTS, (“Petitioner”), files this Administrative Complaint against CHURCH'S CHICKEN, (“Respondent’), and says: 1. Petitioner is the state agency charged with regulating the operation of public lodging establishments and public food service establishments, pursuant to Sec. 20.165 and Chapter 509, Florida Statutes. 2. Respondent is, and has been at all times material hereto, licensed by or subject to the jurisdiction of the Division of Hotels and Restaurants. The respondent's business address of record is 1060 EAST 21ST STREET, JACKSONVILLE, FL 32206.The mailing address of record is LEWIS SIPLIN ENTERPRISES, 1617 ROWE AVENUE, JACKSONVILLE, FL 32208. 3. Inspection of this establishment conducted pursuant to Sec. 509.032, Florida Statutes, revealed violations of the provisions of Chapter 509, Florida Statutes, and / or the rules promulgated thereto governing operation of the establishment. The violation(s) found and applicable law are described in Exhibit “A”, attached hereto and incorporated herein by reference. WHEREFORE, Petitioner respectfully requests entry of an Order imposing one or more of the following penalties: administrative fine not to exceed $1000 per offense; mandatory attendance at Respondent's expense at an educational program sponsored by the Department's Hospitality Education Program; suspension, revocation, or refusal of a license issued pursuant to this Chapter, and/or any other relief authorized by Chapter 509, Florida Statutes, or the rules promulgated thereto. Signed December 31, 2003 za Steven von Bodungén, District Manager By delegation of the Director, or designee Division of Hotels & Restaurants : Department of Business & Professional Regulation COUNSEL FOR THE DEPARTMENT: ewe Gail Scott-Hill, Senior Attorney Florida Bar No. 0909289 Department of Business & Professional Regulation 1940 North Monroe Street, Tallahassee, Florida 32399-1007 Telephone 850 - 488-3140 / Facsimile 850 - 488-5074 CERTIFICATE OF SERVICE BY CERTIFIED U.S. MAIL, ARTICLE NUMBER:_7002 2030 0001 7166 5482 | HEREBY CERTIFY that a true and correct copy of the foregoing ADMINISTRATIVE COMPLAINT has been hand served by me on this day of , 2003. Received by: Inspector's Signature Operator's Signature = ee Title Title Case No: 2003096570 Revised 11/04/2003 License No: 26109014 Business Name: CHURCH'S CHICKEN License Type: 2010 District No: 5 License No: 2610901 License Type: 2010 Case No: 2003096570 Exhibit A "FC" as cited herein references specific provisions of the 1999 Food Code, Recommendations of the United States Public Health Service, Food and Drug Administration, incorporated by Chapter 61C, Florida Administrative Code. “NFPA” as cited herein references specific provisions of the National Fire Protection Association Life Safety Code, incorporated by reference at Chapter 4A-3, “Fire Prevention, General Provisions’, Florida Administrative Code, and 61 C-1,004(5), Florida Administrative Code. Itis alleged that on September 25, 2003 and November 6, 2003 the licensee was in violation of Florida Statute 509(FS) and/or the Rules of the Division of Hotels and Restaurants, Florida Administrative Code (FAC), in the following particulars. Copy(s) of the report(s) for the above referenced inspection(s) are attached hereto and incorporated by reference as Exhibit B. 1, 10-02 3-304.12(A)&(B) FC During pauses in FOOD preparation or dispensing, FOOD preparation and dispensing UTENSILS shail be stored: (A) Except as specified under Paragraph (B) of this section, in the FOOD with their handles above the top of the FOOD and the container: (B) In FOOD that is not POTENTIALLY HAZARDOUS with their handles above the top of the FOOD within containers or EQUIPMENT that can be closed, such as bins of sugar, flour, or cinnamon; OBSERVED SCOOP HANDLE IN SUGAR-BULK CONTAINER. 2. 15-02 4-201.11 FC EQUIPMENT and UTENSILS shall be designed and constructed to be durable and to retain their characteristic qualities under normal use conditions. OBSERVED LID TO BULK SUGAR CONTAINER CRACKED AND BROKEN. 3. 22-02 4-601.11(A) FC EQUIPMENT FOOD-CONTACT SURFACES and UTENSILS shall be clean to sight and touch. OBSERVED CRUSTY WHITE BUILDUP INSIDE ICE MACHINE. 4, 23-01 4-601.11(C) FC NonFOOD-CONTACT SURFACES of EQUIPMENT shall be kept free of an accumulation of dust, dirt, FOOD residue, and other debris. OBSERVED TOP OF ICE MACHINE AND CONVECTION OVEN GREASY AND DUSTY. 5.35B-03 6-202.15 FC Outer Openings, Protected. (A) Except as specified in Paragraphs (B), (C), and (E) and under Paragraph (D) of this section, outer openings of a FOOD ESTABLISHMENT shall be protected against the entry of insects and rodents by: (1) Filling or closing holes and other gaps along floors, walls and ceilings; (2) Closed, tight-fitting windows; and (3) Solid self- closing, tight-fitting doors. (B) Paragraph (A) of this * denotes critical violation ~ Exhibit A Page 1 of 2 License No: 2610901 License Type: 2010 Case No: 2003096570 6. 45-04.1 7. 53A-04 NFPA 10, 1-5.2 61C-4.023(1) FAC * denotes critical violation section does not apply if a FOOD ESTABLISHMENT opens into a larger structure, such as a mall, airport, or office building, or into an attached structure, such as a porch, and the outer openings from the larger or attached structure are protected against the entry of insects and rodents. (C) Exterior doors used as exits need not be self-closing if they are: (1) Solid and tight-fitting; (2) Designated for use only when an emergency exists, by the fire protection authority that has jurisdiction over the FOOD ESTABLISHMENT; and (3) Restricted so they are not used for entrance or exit from the building for purposes other than the designated emergency exit use. OBSERVED AN OPEN SPACE AT BOTTOM OF REAR DOOR. [Moderate] hazard locations consist of dining areas, storage, or support service areas. [These locations shall be protected by the installation of portable fire extinguishers with a minimum rating of] 2A10BC provided for each 1500 square feet of floor space on each level and installed so that the travel distance to any extinguisher shall not exceed 75 feet. OBSERVED NO PORTABLE 2A10BC FIRE EXTINGUISHER . When four or more employees, at one time, are engaged in the storage, preparation or serving of food in a licensed establishment, there shall be at least one certified food protection manager present at all times when said activities are taking place. The certified food protection manager or managers need not be present in the establishment during those periods of operation when there are three for fewer employees engaged in the storage, preparation, or serving of foods. OBSERVED NO PROOF PROVIDED UPON REQUEST OF A CURRENT CERTIFIED FOOD MANAGER PRESENT. MANAGER SHANA PHILLIPS EMPLOYED MORE THAN 90 DAYS. FOUR EMPLOYEES ON THIS SHIFT. ~ Exhibit A Page 2 of 2

Docket for Case No: 04-000389

Orders for Case No: 04-000389