State of Florida Department of Business and Professional Regulation Division of Hotels and Restaurants . DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION Petitioner, vs, License Number 3916115 MAYURI INDIAN CUISINE f License Type 2040 spon Pe Case Number 2013016853 Administrative Complaint The DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION, DIVISION OF HOTELS AND RESTAURANTS, ("Petitioner’), files this Administrative Complaint against MAYURI INDIAN CUISINE, -(’Respondent!),.ANd SAYS: ee 6 eae ee ee eee tnt 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, licensed by or subject to the jurisdiction of the Division of Hotels and Restaurants, The respondent's business address of record is 8447 N 56 ST, TEMPLE TERRACE, FLORIDA 33617.The mailing address of record is MAYURI INDIAN CUISIN E, at 8447 N 56 ST, TEMPLE-TERRACE, FLORIDA 33617. 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 is 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 609, Florida Statutes, or the rules promulgated thereto. Signed April 17, 2013 Sa . Joe Perez; District Manager By delegation of the Director, or designee Division of Hotels & Restaurants Department of Business & 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: i : os | HEREBY CERTIFY that a true and correct copy of the foregoing ADMINISTRATIVE COMPLAINT has been hand served by me on this. day of , 2013. Received by: Inspector's Signature Operator's Signature Title Title Case Number: 2013016853 — File Number: 234010 District Number: 03 License Number: 3916115 2010 : Form revised 01.01.13 MAYURI INDIAN CUISINE : Exhibit A License Number: 3916115 License Type: 2010 PERMANENT FOOD SERVICE Case Number: 2013016853 Itis alleged that on April 9, 2013 Respondent was in violation of Florida Statute 509 (FS); the Rules of the Division of Hotels and Restaurants, Florida Administrative Code (FAC); and/or specific provisions of the Food Code, Recommendations of the United States Public Health Service, Food and Drug Administration, as incorporated by Chapter 61C, 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. ** denotes a high priority violation. * denotes an intermediate priority violation. Observed roach activity present as evidenced by live roaches found; 10 live roaches along prep area/cookline wall, 2 live roaches under beverage machine in kitchen, 3 live roaches under 3 compartment sink and 1 live roach under dishwash machine. Case Number: 2013016853 — File Number: 234010 District Number: 03 License Number: 3916115 2010 Form revised 01.01.13 MAYURI INDIAN CUISINE

Docket for Case No: 13-002598