State of Florida Department of Business and Professional Regulation Division of Hotels and Restaurants DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION Petitioner, vs. < License Number. 2102115 PALOMA BLANCA i dent : License Type 2010 espondent. Case Number [2010052713 / : Administrative Complaint The DEPARTMENT OF BUSINESS AND PROFESSIONAL REG ULATION, DIVISION OF HOTELS AND RESTAURANTS, ('Petitioner'), files this Administrative Complaint against PALOMA BLANCA II, (‘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 Section 20.165 and Chapter 509, Florida Statutes. 2. Respondent is, and has been at all times material hereto, ligensed by or subject to the jurisdiction of the Division of Hotels and Restaurants. The respondent's business address of record is 4881 GOLDEN GATE PKWY, NAPLES, FLORIDA 34116.The mailing address of yecord is PALOMA BLANCA II, at 4884 GOLDEN GATE PKWY, NAPLES, FLORIDA 34116. © 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. Inspection documents are attached as Exhibit "B”, 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 $1,000 per offense,|suspenston, 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 October 21, 2010 b ma . saadload Deputy District Manager By delegation of the Director, or designee Division of Hotels & Restaurants ; Department ofBusiness & Professional Regulation COUNSEL FOR THE DEPARTMENT: Mare Drexler, Lead Attorney Florida Bar No. 0487058 Department of Business & Professional Regulation 1940 North Monroe Street Tallahassee, Florida 32399-2202 Certificate of Service . BY CERTIFIED U.S. MAIL, ARTICLE NUMBER: 7160 3901 9845 5466 8323 | HEREBY CERTIFY that a true and correct copy of the foregoirlg ADMINISTRATIVE COMPLAINT has been hand served by me on this. day of , 2010, Received by; Inspector's Signature Operator's Signature ‘Title a Title Case Number: 2010052713 File Number: 189451 District Number: 07 License Number: 2102115 2010 Form revised 10.04.10 PALOMA BLANCA II Filed October 5, 2011 2:46 PM Division of Administrative Hearings Exhibit A License Number: 2102115 License Type: 2010 PERMANENT FOOD SERVICE Case Number: 2010052713 "FC" as cited herein references specific provisions of the 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 61C-1.004(5), Florida Administrative Gode. “ denotes a critical violation. It is alleged that on September 28, 2010 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. * 4, 52-01-1 509.292(1) FS:: (1) AN OPERATOR MAY NOT KNOWINGLY AND WILLFULLY MISREPRESENT THE IDENTITY OF ANY FOOD OR FOOD PRODUCT TO ANY OF THE PATRONS OF SUCH ESTABLISHMENT. THE IDENTITY OF FOOD OR A FOOD PRODUCT IS MISREPRESENTED IF: (A) THE DESCRIPTION OF THE FOOD OR FOOD PRODUCT |S FALSE OR MISLEADING IN ANY PARTICULAR; (B) THE FOOD OR FOOD PRODUCT IS SERVED, SOLD, OR DISTRIBUTED UNDER THE NAME OF ANOTHER FOOD OR FOOD PRODUCT; OR (C) THE FOOD OR FOOD PRODUCT PURPORTS TO BE OR IS REPRESENTED AS A FOOD OR-FOOD PRODUCT THAT DOES NOT CONFORM TO A DEFINITION OF IDENTITY AND STANDARD OF QUALITY IF SUCH DEFINITION OF IDENTITY AND _STANDARD OF QUALITY HAS BEEN ESTABLISHED BY CUSITOM AND USAGE. IDENTITY OF FOOD OR FOOD PRODUCT MISREPRESENTED, GROUPER ON MENU, OPERATOR'S | KITCHEN STAFF INDICATED TWO BOXES OF SWAI BEING|USED FOR GROUPER. RED SNAPPER ON MENU, KITCHEN STAFF INDICATED BOX AND BIN OF KING FISH BEING USED FOR SNAPPER. Case Number: 2010052713 — File Number: 189451 District Number: 07 License Number: 2102115 2010 : Form revised 10.04.10 PALOMA BLANCA II

Docket for Case No: 11-005123