State of Florida Department of Business and Professional Regulation Division of Hotels and Restaurants DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION Petitioner, vs \ License Number 1617756 MOM'S KITCHEN dent License Type 2010 espon ra Case Number 2010060086 Administrative Complaint The DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION, DIVISION OF HOTELS AND RESTAURANTS, ("Petitioner’), files this Admmnistratve Complaint against MOM'S KITCHEN, ("Respondent’), and says 1 Petitioner ts the state agency charged with regulating the operation of public lodging establishments and pubitc food service establishments, pursuant to Section 20 165 and Chapter 509, Florida Statutes 2 Respondent ts, 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 1940 NE 45 ST, OAKLAND PARK, FLORIDA 33308 The mailing address of record is MOM'S KITCHEN, at 1940 NE 45 ST, OAKLAND PARK, FLORIDA 33308 3 Inspection of this establishment conducted pursuant to Sec 509 032, Florida Statutes, reveated 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, 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 10, 2010 } Ken Buck, District Manager By delegation of the Director, or designee Division of Hotels & Restaurants Department of Business & Professional Regulation COUNSEL FOR THE DEPARTMENT Marc 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: | HEREBY CERTIFY that a true and correct copy of the foregoing ADMINISTRATIVE COMPLAINT has been hand served by me on this day of , 2010 Received by inspector's Signature Operator's Signature Title Title Case Number 2010060086 File Number 104990 District Number 02 License Number 1617756 2010 Form revised 10 04 10 MOM'S KITCHEN Filed December 14, 2011 2:43 PM Division of Administrative Hearings Exhibit A License Number 1617756 License Type 2010 PERMANENT FOOD SERVICE Case Number 2010060086 “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 Code “” denotes a critical violation It 1s alleged that on November 8, 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 inoarporated by reference as Exhibit B * 1 52-01-1 508292(1)FS (1) ANOPERATOR 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 JS MISREPRESENTED IF (A) THE DESCRIPTION OF THE FOOD OR FOOD PRODUCT IS FALSE OR MISLEADING IN ANY PARTICULAR, (B) THE FOOD OR FOOD PRODUCT !S 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 CUSTOM AND USAGE OBSERVED IDENTITY OF FOOD OR FOOD PRODUCT MISREPRESENTED: CRAB SALAD ON MENU - IMITATION CRAB MEAT USED. Case Number 2010060086 File Number 104990 District Number 02 License Number 1617756 2010 Form revised 10 04 10 MOM’S KITCHEN

Docket for Case No: 11-006400