This Declaration is to affirm that (Name of for-profit entity) is requesting an exemption from permit requirements for food facilities under the provisions of Section 113789(c)(a) of the California Retail Food Code, which allows the above named for-profit entity to give or sell food and/or beverages at an event that occurs not more than three days in a 90-day period for the benefit of the nonprofit association: Casa Pacifica Centers for Children and Families – 1722 S. Lewis Rd. Camarillo, CA 93012 on June 2, 2024 for the benefit of Casa Pacifica Centers for Children and Families. I certify that the above is true and correct to the best of my knowledge and belief. I further certify under penalty of perjury that the above named for-profit entity will receive no monetary benefit other than that resulting from recognition for participating in the event. I understand that I may not sell or take orders for any food or beverage product at this event for which I receive compensation.

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