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HomeMy WebLinkAboutQdoba Mexican Eats #2365 - 12/31/2021FOR BOARD OF HEALTH USE ONLXr Permit # Issu d FOOD ESTABLISHMENT PERMIT APPLICATION/ (Application must be submitted at least 30 days before the planned op4ning r Establishment Name (Qck vo, �e _kcc✓i ZUtIIS'' 2-369 Establishment Address 2-90 S'ClAoo' t Establishment Mailing Address (if different) 3S© CCVv 1'10 e4e, la (ZC'Lrnc` (1`k- LAOD S'an6 9210r3 Establishment Telephone No 5C)0 -.33-7 r,;LH O O Applicant Name & Title: o pvl V 1 RkC0C'j I S . �(Cp' Lx_ Applicant Address 95a Ccc_"VL 10 Ul,e, (G- 400 5 a'q bt es o , C✓1 9d-108 Applicant Telephone No.: gjg -• `Z to (p -q OCD 24 Hour Emergency No.: Applicant Email Lo'S vtL�S � ICE vl S,e- S do l a - C oven Owner Name & Title (If different from applicant) C(e(Do, ��ru tt Ccy-p p,rcL-h� 117' Owner Address gS� �0.nn ✓t0 CU, (C_ 6L,, 9U qoD Sam 17te�0, Cm9 CId-108 Owner telephone number �j $�_ t (D(o' u(S,DO Owner email: &lltce'-Is 4,(oy-n Establishment Owned By: If a corporatio or partnership, give name, title, and home address of officers or O An Association partner. W-A Corporation Title Address Nam�e` [A An Individual L /� t� �_P'liboxalt PAtd it e A CEO OSDC0.�t, o (le L lt2cr� S kq �( � ty , �QCC 3S?� Cu.vLIno dP lc t%�LAC,t(1P 4[k� FJI A Partnership ❑O Other legal Entity Person Directly Responsible For Daily Operations (owner, person in charge, supervisor, manager etc.) Name & Title: rivv vnko' L. i�/\u✓ Q nn �+ n Address: \� CU �� 0.c J l k ✓N Cr CUB tccQ , lv i Y0.S+ I✓/L�vt nce 12 1 02-6i 1( Telephone No: i 3 a � � (a- -) P'o Z 24 Hour Emergency No: FAX: E-mail: &000;L3&T ��p��Q, ((TrYI Alt E-Mail: District Or Regional Supervisor (if applicable L A Y�&CO— Name &Title: r*Y-V jv L S Address: TelephoneNo:�5e-t!/U,--324 Hour Emergency No: FAX: E-mail: \DiQ,GiYYDU� ��dA6o,eoyr) os�>t�o inn Dies a 1 �lY108 Food Establishment Information WATER SOURCE: LU n l p SEWAGE DISPOSAL: No. of Food Employees: - 6P DEP Public Water Supply No: (If applicable) DAYS/HOURS mom,- 10" �'o a'M- to.'OD Name of Person(s) In Charge Certified in Food Protection Management: Name of Person(s) In Charge Certified in Allergen Awareness Training Jt'k L V CLU 7'ZU.Zk61 Name of pest control company routinely inspecting the premises for evidence of pests aC ✓l If there is seating for 25 people or more, a person trained in manual choke saving procedures will be onsite at all times food is being prepared. VYes Does this establishment require a FOG permit? If yes, please attach the FOG permit application. Length of Permit: Establishment Type: ($.Annual Tj Retail Food $125.00 [a Mobile Food Consession 0 Temporary ,Food Service up to 100 INCLUDING NO PHF PREPARED ON SITE $100.00 Temporary Start Date: FOOD TRUCKS $175.00 O Manufacture Frozen Desserts/Ice Cream Food Service up to 101 -200 $250.00 $25.00/freezer Temporary End Date: Food Service up to 201 + $300.00 0 Pushcart $50.00 # of Pushcarts: Temporary Time: ❑-� Supermarkets $400 Residential Kitchen $100.00 Rain Date: &Milk & Cream $10.00 II Caterer $35.00 Food Operations: Definitions:PHF - Potentially hazardous food(time/temperature controls required) (Check all that apply): Non-PHFs- non -potentially hazardous food(no time/temperature controls required) RTE- ready -to -eat foods (Ex. sandwiches, salads, muffins which need no furtherprocessing) Sale of Commercially Pre -Packaged Non-PHFs ❑] PHFCooked To Order Q Hot PHF Cooked and Cooled or Hot Held 0 Sale of Commercially Pre -Packaged PHFs XPreparation of PHFs For Hot And for More Than a Single Meal Service ❑7 Delivery of Packaged PHFs Cold Holding For Single Meal Service r] PHF and RTE Foods Prepared For Highly Susceptible Population Facility F1 Sale of Raw Animal Foods Intended Reheating of Commercially to be Prepared by Consumer Use of Process Requiring A Variance Processed Foods for Service Within 4 Hours Customer Self -Service and/or HACCP Plan (including bare hand Customer Self -Service of Non PHF and Non- contact alternative, time as a public health Perishable Foods Only Ice Manufactured and Packaged for control) [:13 Preparation of Non-PHFs Retail Sale Offers Raw Or Undercooked Food Of ITJ Juice Manufactured and Packaged for Animal Origin Other Food Operations Retail Sale Vacuum Packaging /Cook Chili EJ Offers RTE PHF in Bulk Quantities Prepares Food/Single Meals for Retail Sale of Salvage, Out -Of -Date Catered Events or Institutional Food Service or Reconditioned Food 1, the undersigned, attest to the accuracy of the information provided in this application and affirm that the food establishment operation will comply with 105 CMR 590.000 and all other applicable law. I have been instructed by the board of health on how to obtain copies of 105/PMR M000 and the federal Food Code. Signature of Applicant: Pursuant to MGL Ch.62C, sec. 49A, I certify under the penalties of perjury that 1, to my best knowledge and belief, have filed all state tax returns and paid state taxes required under law. Social Security Number or Federal ID:©�� �� rc�1 �� �� _(L(�O,� \r Signature of Individual or Corporate Name: (� -"T' Q ol,i TAX CERTIFICATION FORM I certify under the penalties of perjury that 1, to my best knowledge and belief, have filed all state tax returns and paid all state taxes required under law. Signature of Individual or Corporate Name By: Corporate Officer (Mlffdatony if Applicable) ,94- l+-l�3o-1aS "Social Security No. (Voluntan/) or Federal Identification Number *This license will not be issued unless this certification clause is signed by the applicant. ** Your social security number will be furnished to the Massachusetts Department of Revenue to determine whether you have met tax filing or tax payment obligations. Licensees who fail to correct their non -filing or delinquency will be subject to license suspension or revocation. This request is made under the authority of Massachusetts General Law Chapter 62C, section 49A. C:\UsersWeite\Desktop\Seott's Documents\Food Establishments- Temp\TAX CERTIFICATION PORM.doc The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 U1V www.mass.gov/dia Workers' Compensation Insurance Affidavit: General Businesses Applicant Information Please Print Legibly Business/Organization Address: :3S V l &,,vy LEI iD City/State/Zip: of b l.Ct; b q--2-14hone #: l? !S3 ^ Z to (o - t-( O Ly /O u Are you an employer? Check the appropriate box: Business Type (required): 1. �- l am a employer with _ employees (full and/ 5. Retail or part -tine).* 2. ❑ I have 6. VBestaurant/BadEating Establishment am a sole proprietor or partnership and no 7. Office and/or Sales (incl. real estate, auto, etc.) employees working for me in any capacity. 8. Non-profit [No workers' comp. insurance required] 3.❑ We are a corporation and its officers have exercised 9. Entertainment their right of exemption per c. 152, § 1(4), and we have 10Manufacturing no employees. [No workers' comp, insurance required]* 4. We are a non-profit organization, by 11.0 Health Care staffed volunteers, 12.Q Other• with no employees. [No workers' comp. insurance req.] *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. **If the corporate officers have exempted themselves, but the corporation has other employees, a workers' compensation policy is required and such an organization should check box 41. I am an employer that is proving workers' compensation insurance for my employees. Below is the policy information. Insurance Company Insurer's Address: City/State/Zip: Policy # or Self -ins, Lie. # I�l/l o_ ( 3 (Oy U c)—n Expiration Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify, under thepains a penalties ofperjuny that the information provided above is true and correct. Signature: t s_U�vv v A��— I.a t� Date: In f I i-I 11?-p Phone #: C S � — " 2 U (O — q & 0 a / Ofjtcial use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Cleric 4. Licensing Board 5. Selectmen's Office 6. Other Contact Person: Phone www.mass.gov/dia orDATE( A 41 CERTIFICATE OF LIABILITY INSURANCE 04/0612020 I THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsempent(s). PRODUCER TACT C(AIA E: RonN New York NV Office Inc New Risk Services Northeast, P r lac rvo. ExO: (866) 283-7122 `p/c. non: (580) 363-0105 Ai%A1L : One Liberty Plaza 165 Broadway, suite 3201 New York NY 10006 USA INSURER(S) AFFORDING COVERAGE NAICN INSURED INSURERA: Praetorian insurance Company 37257 INSURER B : 5Obd Restaurant Corporation 3 Camino De La Re1na, 4th Floor San Die San Diego CA 92108 USA INSURER L: NSURCR RED: NSUR E: INSURERF. COVERAGES CERTIFICATE NUMBER: 570081365129 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, Limits shown are as requested PER LTR TYPE OF INSURANCE ADOL INSD SUBR Me POLICY NUMBER POLICY EFF (MMIODrvYYY) OLILY E%P I AIIDDIYYYY) LIMITS COMMERCWL GENERAL LIABILITY EACHOCCURRENCE DAMAGETO PREMISES(ERTM ncel CLAIMS -MADE❑ OCCUR NED E%P(My one person) PERSONALBADV INJURY GEN'LAGGREGATE LIMITAPPLIES PER GENERAL AGGREGATE POLICY ❑RD- ,IECi LOC PRODVCTS-COMP/OPAGG OTHER. AUTOMOBILE LIABILITY A COMBINED SINGLE LIMIT (Ea a¢Menf) BODILY INJURY( Per person) ANY AOTO BODILY INJURY (Per aaldern SCHEDOLED OWNED AUTOS .— TY DAMAGE (Perawid (Penl) AUTOS ONLY HIREDgIR05 NONAWNED ONLY AUTOS ONLY UMIBILLALIATI OCCUR EACHOCCURRENCE AGGREGATE EXCESS LIAO CLAIMS -MADE DEO gETENTION A WORKERS COMPENSATION ANN CWC1364629 03/21/2020 03/21/2021 X PER STATUTE POLL - EMPLOYERS' LIABILITY YIN ANYaETCRIPARTNER/ EL EACH ACCIDENT $1, 000, 000 CFFCEWMEMRER N (Mhuranury In NH NIAEUTIFIE ELDISEABEEAEMPLOYEE $1,000, OOg VVc.ESCRIPTmN OF OPERATIONS pelwi EL G-ASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VERICLES(ALORG 101, Additional Remarks Schedule, may M attached If more apace Is requlrN) Evidence of workers' Compensation coverage. CERTIFICATE HOLDER CANCELLATION ii'- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Qdoba Restaurant corporation AUTHORIZED REPRESENTATIVE 350 Camino Be La Relna, 4th Floor San Diego CA 92108 USA �% �� Q !/'gyp � Q� tJ2lCM ✓Le0/G �iGefi'eN c/Y/ELfxrF0 JL ©1988-2015 ACORD CORPORATION. All rights reserved ACORD 25 (2016103) The ACORD name and logo are registered marks ofACORD I9 z 0 LLM V_ W M z D M N O N co V V 4 N O) N Z � N o N Q m c+ Cd � o � O 0 y v 2 O w � � y N 0 W la A � N C a I�c +/ \ Aa7 / a g / 70- \ , k \ \ Imm \ \ / \ \ CD / / ) )\/ = 2 _ < s \ \ 0 . « s_ P o = ) ® » a ) ) « ° \ \ § \ / Town of Mansfield Health Department RESTAURANT& FOOD PREPARATION ESTABLISHMENTS Business/ Food Establishment Name: \ 4f `'y(C-'ppq CL 0�3 BPS Address: �� �G%lbe�� ! `+. � ��l V00 n'el-.eAr.Q t mA J1U7�1�`-1 ,jE 6-v sF06Yn 0 4§V, Mailing Address:_ &AA,V Ytp (LQ lra (Lc'no, .�k LjOb an VieC O Phone/Faftx,,Number: U�a �10(t —L( �Do i�6Y0 5-00'337 dC-lCZ) Email: �-l.lsI'Le' 3 0— CO,-" &MCl�0�3U5(�4(QO�C�.r(R� Cr Contact Person/Title for Grease Traps:�f���✓/, A � n j S 1 Name of Company scheduled to pump internal grease trap(s) monthly: SLM h�sfe 1// ,jta: Name of Company scheduled to pump external grease trap quarterly: SL-/✓] Iy(sk,. ✓VLS N t Please attach the following documents to this application: <2cSu.l�e b • Most recent waste hauler receipt or waste hauler manifest — he �+ (tC� �nonssi�t� dvtc r(D • Appropriate permit fee based on new fee schedule (Checks can be made out to the Town of J Mansfield) Food Establishments Fee 3 grease interceptors/traps or less and/or 1 yellow grease collection $SO container Each grease interceptor/trap over 3 $50 ($200 max) I THE UNDERSIGNED HAVE OBTAINED AND REVIEWED THE MANSFIELD BOARD OF HEALTH FATS, OILS, AND GREASE (FOG) REGULATIONS APPROVED AND ADOPTED ON OCTOBER 4, 2018. In consideration of the granting of the permit, the undersigned agrees to the conditions of the permit and acknowledges that the information submitted in these documents is true, accurate and complete. Date VE) I i, (p I :�-D Print Name vin( e-A V eW v .te— Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However, the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply your insurance company's name, address and phone number along with a certificate of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self -insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the pennit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permiNlicense applications in any given year, need only submit one affidavit indicating current policy information (if necessary). A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 www.mass.gov/dia Fain Revised 5-26-05 Facility Operational Information Please answer all questions in this section. If an item is not applicable, indicate "N/A". Unless otherwise specified, please print or type. Seating Capacity (per Fire Department Regulation): Seating Capacity (Actual Count): (G ClAcl,4 Normal Hours of Food Preparation/Service: Monday 10:3Ua ,—f0.770/I04 Thursday 10:40& x - 10:-OVn,tA Sunday Tuesday®vo Wednesday jo; Dow ta)(�QyL Friday W 3 0&b - 9i `00n yi Saturday 1o. -jD ,,j , 10: oD p,v, Please indicate the NUMBER of kitchen fixtures used in your establishment and if it is attached to a Grease Removal Units (GRU/trap) Number in establishment Attached to GRU compartment sink Handwashing sink Commercial Dishwasher Barsink Mop Sink Garbage Disposal Ice Making Machines Fryolators Grills or Ovens Exhaust Hoods Floor drains Other: How are hood vents cleaned? (i.e., in three (3) bay sink, off site by private company): Is dinnerware pre -rinsed before being washed? If yes, at what station/sink? 2 Yes ' L.. No Grease Trans and Grease Removal Internal Grease Traps How many indoor Grease Removal Units (GRU/trap) are on site? Please list fixtures attached to each grease trap Grease Trap 1 L4. S[ L, — c Grease Trap 2 Grease Trap 3 Grease Trap 4 Grease Trap 5 External Grease Traps Does this establishment have an outdoor Grease Removal Unit (GRU/Interceptor)? IL Yes No Size 55 gallons Where is the existing outdoor GRU located? 10114 If the owner is responsible for external trap pumping, provide the Name, Address and Telephone Number of the property owner below: Property Owner's Name: Property Owners Address: Property Owner's Telephone Number: Yellow Grease Waste Do you store yellow grease waste from fryolators? f Where is the grease storage unit located? _�SLL/ alweL, How often is this grease storage unit emptied? 4 Please list the vendor who removes the waste: SLM - TOWN OF MANSFIELD LOCAL BYLAWS The following bylaws apply to all food establishments permitted by the Mansfield Health Department: Plastic Waste Reduction; Polystyrene Container Reduction; and Plastic Straw/Stirrer Reduction. A copy of each bylaw is included. It is the responsibility of the applicant to read and understand all bylaws. Please indicate by initialing the following statements that the permitted food establishment will adhere to all applicable bylaws. The applicant and associate corporation are subject to fines associated with violations. Plastic Waste Reduction No retail establishment in the Town of Mansfield shall provide thin-film, single -use plastic check-out bags to customers. nN I have received a copy of the Plastic Waste Reduction bylaw. I understand my responsibility to ensure that this bylaw is adhered to at the permitted food establishment. I understand violations of this bylaw will result in fines. Polystyrene Container Reduction (effective January 1, 2021) Food establishments are prohibited from dispensing prepared food and drink in disposable food service containers made from expanded polystyrene. All food establishments are strongly encouraged to use reusable food service containers and cutlery, and when possible biodegradable, compostable alternatives. Compostable materials must meet ASTM (American Society of the International Association for Testing and Materials) Standards for compostability. l` A'V I have received a copy of the Polystyrene Container Reduction bylaw. I understand my responsibility to ensure that this bylaw is adhered to at the permitted food establishment. I understand violations of this bylaw will result in fines. Plastic Straw/Stirrer Reduction (effective January 1, 2021) Plastic beverage straws and plastic stirrers shall not be used or dispensed or sold except upon request in conjunction with the serving by business establishments or at any town -sponsored event of liquid, slurry, frozen, semi -frozen, or other forms of beverages to the public for consumption. `L✓I have received a copy of the Plastic Straw/Stirrer Reduction bylaw. I understand my responsibility to ensure that this bylaw is adhered to at the permitted food establishment. I understand violations of this bylaw will result in fines. Applicant Signature AuA61� �' ^�_ Date: Applicant Name (pleVase print clearly) \(tL OJT aV\_ " § 180-17 ARTICLE III Plastic Waste Reduction [Added 4-10-2018 ATM by Art. 451 § 180-16. Purpose. The purpose of this bylaw is to protect the Town's natural beauty and irreplaceable natural resources by reducing the number of single -use plastic check-out bags that are distributed and used in the Town of Mansfield and to promote the use of reusable bags. § 180-17. Definitions. The following words shall, unless the context clearly requires otherwise, have the following meanings: CHECK-OUT BAG — A bag provided by a store to a customer at the point of sale. Check-out bags shall not include bags, whether plastic or not, in which loose produce or products are placed by the consumer to deliver such items to the point of sale or check-out area of the store. DEPARTMENT — The Mansfield Health Department. HEALTH AGENT — The Health Agent for the Mansfield Board of Health or their designee. RECYCLABLE PAPER BAG — A paper bag that is 100% recyclable and contains at least 40% post -consumer recycled content, and displays in a visible manner on the outside of the bag the word "recyclable" or a symbol identifying the bag as recyclable and a label identifying the bag as being made from post -consumer recycled content and the percentage of post -consumer recycled content in the bag. RETAIL ESTABLISHMENT — Any business facility that sells goods directly to the consumer, whether for or not for profit, including, but not limited to, retail stores, restaurants, pharmacies, convenience and grocery stores, liquor stores, seasonal and temporary businesses. REUSABLE CHECK-OUT BAG — A sewn bag with stitched handles that is specifically designed for multiple reuse and that: A. Can carry 25 pounds over a distance of 300 feet; B. Is machine washable; and C. Is either: (1) Made of natural fibers (such as cotton or linen); or 1