FD

FD

FD

FD

FD
n

n
io

io

io

io

io
at

at

at

at

at
Date:04/22/2024 19:20:39
tr

tr

tr

tr

tr

t
is

is

is

is

is

is
Please review the registration.
eg

eg

eg

eg

eg

eg
Created Date Created by

2024-04-17 17:07:15.0 sil20410

R

R
Registration Expiration Date Registration Renewed Date
y

y
lit

lit

lit

lit

lit

lit
2024-12-31
ci

ci

ci

ci

ci

ci
Last Modified by
Fa

Fa

Fa

Fa

Fa

Fa
FEI_NUMBER_UPDATE

Last Updated
od

od

od

od

od

od
2024-04-18

Last Modified by Company Registration Status

Fo

Fo

Fo

Fo

Fo

Fo
INVERSIONES FLOREZCOOK SAS VALID
A

A
Is this facility engaged in the manufacturing/processing, packing, or holding of food for human or animal consumption in the United States?
FD

FD

FD

FD

FD

FD
¤Yes ¡No
Are you a fishing vessel engaged in processing (21 CFR 1.226(f))?

¡Yes ¤No
n

n
io

io

io

io

io

io
Section 1: Type of Registration
at

at

at

at

at

at

a
Facility Location: Foreign Registration
tr

tr

tr

tr

tr

tr
Initial Registration 15358779912 Pin No 5GGB70eg
is

is

is

is

is

is
Are you the new owner of a previously registered facility?
eg

eg

eg

eg

eg

eg
¡Yes ¤No
R

R
Previous Owner's Title:
ty

y
lit

lit

lit

lit

lit

lit
Previous Owner's Name:
ci

ci

ci

ci

ci

ci
Previous Owner's Registration Number:
Fa

Fa

Fa

Fa

Fa

Fa
Section 2: Facility Name/Address Information
d

od

od

od

od

od

Facility Name Telephone Number

oo

INVERSIONES FLOREZCOOK SAS 057 315 3809691

Fo

Fo

Fo

Fo

Fo

Fo
Facility Name Suffix Fax Number

Company
A

A
FD

FD

FD

FD

FD

FD

Facility Street Address, Line 1 E-Mail Address

Calle 44 B 68 A 21 [email protected]

Facility Street Address, Line 2 Unique Facility Identifier (UFI)

on

n
io

io

io

io

io

io

Calle 44 B 68 A 21 679900560
at

at

at

at

at

at

City
tr

tr

tr

tr

tr

tr

Medellin
is

is

is

is

is

is

State/Province/Territory
eg

eg

eg

eg

eg

eg

Antioquia
R

R
ity

ity

ity

ity

ity
 FD

FD

FD

FD

FD
n

n
io

io

io

io

io
at

at

at

at

at
tr

tr

tr

tr

tr
Zip Code (Postal Code)

t
is

is

is

is

is

is
057
eg

eg

eg

eg

eg

eg
Country/Area

COLOMBIA
R

R
Section 3: Preferred Mailing Address Information
y

y
lit

lit

lit

lit

lit

lit
Complete this section if different from Section 2 Facility Name/Address Information (OPTIONAL)
ci

ci

ci

ci

ci

ci
Is the preferred mailing address the same as the facility address (Section 2)? Yes
Fa

Fa

Fa

Fa

Fa

Fa
Name Telephone Number

INVERSIONES FLOREZCOOK SAS 057 315 3809691

od

od

od

od

od

od
Address, Line 1 Fax Number
Fo

Fo

Fo

Fo

Fo

Fo
Calle 44 B 68 A 21

Address, Line 2 E-Mail Address

A

A
Calle 44 B 68 A 21 [email protected]
FD

FD

FD

FD

FD

FD
City

Medellin
n

n
io

io

io

io

io

io
State/Province/Territory

Antioquia
at

at

at

at

at

at

a
tr

tr

tr

tr

tr

tr
Zip Code (Postal Code)
is

is

is

is

is

is
057
eg

eg

eg

eg

eg

eg
Country/Area

COLOMBIA
R

R
Section 4: Parent Company Name/Address Information
ty

y
lit

lit

lit

lit

lit

lit
(If applicable and if different from Sections 2 and 3). If information is the same as another section, check which section:
ci

ci

ci

ci

ci

ci
¤Same as Facility Address (Section 2)
Fa

Fa

Fa

Fa

Fa

Fa
¡Same as Preferred Mailing Address (Section 3)
¡None of the above
d

od

od

od

od

od
oo

Company Name Telephone Number

Fo

Fo

Fo

Fo

Fo

Fo
INVERSIONES FLOREZCOOK SAS 057 315 3809691

Company Name Suffix Fax Number

A

Company
FD

FD

FD

FD

FD

FD

Address, Line 1 E-Mail Address

Calle 44 B 68 A 21 [email protected]
on

Address, Line 2
io

io

io

io

io

io

Calle 44 B 68 A 21
at

at

at

at

at

at

City
tr

tr

tr

tr

tr

tr

Medellin
is

is

is

is

is

is
eg

eg

eg

eg

eg

eg

State/Province/Territory

Antioquia
R

R
ity

ity

ity

ity

ity
 FD

FD

FD

FD

FD
n

n
io

io

io

io

io
at

at

at

at

at
tr

tr

tr

tr

tr
Zip Code (Postal Code)

t
is

is

is

is

is

is
057
eg

eg

eg

eg

eg

eg
Country/Area

COLOMBIA
R

R
Section 5: Facility Emergency Contact Information
y

y
lit

lit

lit

lit

lit

lit
If information is the same as another section, check which section:
ci

ci

ci

ci

ci

ci
¤Same as Facility Address (Section 2)
Fa

Fa

Fa

Fa

Fa

Fa
¡Same as U.S. Agent Information (Section 7)
¡None of the above
od

od

od

od

od

od
Individual's Title (Optional) Emergency Contact Phone
Fo

Fo

Fo

Fo

Fo

Fo
057 315 3809691

Individual's Name (Optional) E-Mail Address

A

A
[email protected]
FD

FD

FD

FD

FD

FD
Individual's Middle Name (Optional) Job Title (Optional)
n

n
Individual's Last Name (Optional)
io

io

io

io

io

io
Section 6: Trade Names
at

at

at

at

at

at

a
(If this facility uses trade names other than that listed in Section 2 above, list them below (e.g., "Also doing business as," "Facility also known as"))
tr

tr

tr

tr

tr

tr
is

is

is

is

is

is
Are there alternate trade names used by your facility in addition to the name provided in Section 2: Facility Name/Address Information?

¡Yes
eg

eg

eg

eg

eg

eg
¤No
R

R
Section 7: United States Agent
ty

y
lit

lit

lit

lit

lit

lit
(To be completed by facilities located outside any state or territory of the United States, District of Columbia, or The Commonwealth of Puerto Rico)
ci

ci

ci

ci

ci

ci
First Name Telephone Number
Fa

Fa

Fa

Fa

Fa

Silvia 813 4920071 null

Fa
Middle Name (Optional) Emergency Contact Phone
d

od

od

od

od

od

813 4920071
oo

Fo

Fo

Fo

Fo

Fo

Fo
Last Name Fax Number

Ospina
A

Title (Optional) E-Mail Address

FD

FD

FD

FD

FD

FD

Ingeniera [email protected]

Address, Line 1
on

2854 Morning Glory Cir. Davie Fl 33328

io

io

io

io

io

io

Address, Line 2
at

at

at

at

at

at

City
tr

tr

tr

tr

tr

tr

Cooper City
is

is

is

is

is

is

State/Province/Territory
eg

eg

eg

eg

eg

eg

Florida
R

R
ity

ity

ity

ity

ity
 FD

FD

FD

FD

FD
n

n
io

io

io

io

io
at

at

at

at

at
tr

tr

tr

tr

tr
Zip Code (Postal Code)

t
is

is

is

is

is

is
33328
eg

eg

eg

eg

eg

eg
Country/Area

UNITED STATES
R

R
Section 8: Seasonal Facility Dates of Operation (Optional)
y

y
lit

lit

lit

lit

lit

lit
Give the approximate dates that your facility is open for business, if its operations are on a seasonal basis (Optional).
ci

ci

ci

ci

ci

ci
Harvest 1
Fa

Fa

Fa

Fa

Fa

Fa
Start Month End Month

January December
od

od

od

od

od

od
Harvest 2
Fo

Fo

Fo

Fo

Fo

Fo
Start Month End Month

Section 9: General Product Categories - Human/Animal/Both

A

A
FD

FD

FD

FD

FD

FD
þFood for Human Consumption ¨Food for Animal Consumption
Section 9a: General Product Categories - Food for Human Consumption; and Type of Activity Conducted at the
n

n
Facility
io

io

io

io

io

io
To be completed by Ambient Food Refrigerated Food Frozen Food Acidified Low- Interstat Contract Labeler / Manufact Packer / Salvage Farm Other
at

at

at

at

at

at

a
all food facilities. Storage Warehouse Storage Warehouse Storage Warehouse Food Acid e Sterilizer Relabele urer / Repacke Operator Mixed- Activity
tr

tr

tr

tr

tr

tr
Please see / Holding Facility / Holding Facility / Holding Facility Process Food Conveya r Process r (Recondi Type Conduct
is

is

is

is

is

is
instructions for (e.g., storage (e.g., storage (e.g., storage or Process nce or tioner) Facility ed
eg

eg

eg

eg

eg

eg
further examples. IF facilities, including facilities, including facilities) or Caterer / (Please
R

R
NONE OF THE storage tanks, grain storage tanks) Catering Specify)

MANDATORY elevators) Point

ty

y
lit

lit

lit

lit

lit

lit
CATEGORIES

BELOW APPLY,
ci

ci

ci

ci

ci

ci
SELECT BOX 37
Fa

Fa

Fa

Fa

Fa

Fa
3.BAKERY
d

od

od

od

od

od

PRODUCTS,
oo

DOUGH MIXES, OR þ þ þ þ þ þ þ þ þ þ þ þ ¨
Fo

Fo

Fo

Fo

Fo

Fo
ICINGS[21 CFR 170.3 (n)

(1), (9)]
A

Section 10: Owner, Operator, or Agent-in-Charge Information

FD

FD

FD

FD

FD

FD

Provide the following information, if different from all other sections on the form. If information is the same as another section of the form, check which

section:
on

If information is the same as Section 2, check the box:

io

io

io

io

io

io

¤Section 2 - Facility Address Information

at

at

at

at

at

at

¡Section 3 - Preferred Mailing Address Information

tr

tr

tr

tr

tr

tr
is

is

is

is

is

is

¡Section 4 - Parent Company Address Information

eg

eg

eg

eg

eg

eg

¡Section 7 - US Agent Address Information

¡None of the above
R

R
ity

ity

ity

ity

ity
 FD

FD

FD

FD

FD
n

n
io

io

io

io

io
at

at

at

at

at
Name of Entity or Individual Who is the Owner, Operator, or Agent-in-Charge: ALEJANDRO FLOREZ BOHORQUEZ
tr

tr

tr

tr

tr

t
is

is

is

is

is

is
Address, Line 1 Telephone Number
eg

eg

eg

eg

eg

eg
Calle 44 B 68 A 21 057 315 3809691
R

R
Address, Line 2 Fax Number

Calle 44 B 68 A 21
y

y
lit

lit

lit

lit

lit

lit
City E-Mail Address
ci

ci

ci

ci

ci

ci
Medellin [email protected]
Fa

Fa

Fa

Fa

Fa

Fa
State/Province/Territory

Antioquia
od

od

od

od

od

od
Zip Code (Postal Code)
Fo

Fo

Fo

Fo

Fo

Fo
057

Country/Area
A

A
COLOMBIA
FD

FD

FD

FD

FD

FD
Section 11: Inspection Statement

þFDA will be permitted to inspect the facility at the time and in the manner permitted by the Federal Food, Drug, and Cosmetic Act.
n

n
io

io

io

io

io

io
Section 12: Certification Statement
at

at

at

at

at

at

a
The owner, operator, or agent-in-charge of the facility, or an individual authorized by the owner, operator, or agent-in-charge of the facility, must
tr

tr

tr

tr

tr

tr
submit this form. By submitting this form to FDA, or by authorizing an individual to submit this form to FDA, the owner, operator, or agent-in-charge of the
is

is

is

is

is

is
facility certifies that the above information is true and accurate. An individual (other than the owner, operator or agent-in-charge of the facility) who submits
eg

eg

eg

eg

eg

eg
the form to the FDA also certifies that the above information submitted is true and accurate and that he/she is authorized to submit the registration on the

facility's behalf. An individual authorized by the owner, operator, or agent-in-charge must below identify by name the individual who authorized submission
R

R
of the registration. Under 18 U.S.C 1001, anyone who makes a materially false, fictitious, or fraudulent statement to the U.S. Government is subject to
ty

criminal penalties.
y
lit

lit

lit

lit

lit

lit
NAME OF PERSON SUBMITTING THIS REGISTRATION FORM: Silvia Marcela Ospina
ci

ci

ci

ci

ci

ci
CHECK ONE BOX
Fa

Fa

Fa

Fa

Fa

Fa
¤A. INDIVIDUAL ASSOCIATED WITH THE INFORMATION IN SECTION 10 (STOP HERE, FORM IS COMPLETED)
d

od

od

od

od

od

¡B. ANOTHER AUTHORIZED INDIVIDUAL

oo

Fo

Fo

Fo

Fo

Fo

Fo
Address Information for the Authorizing Individual:
A

Individual's Name Telephone Number

FD

FD

FD

FD

FD

FD

-N/A- -N/A-

Address, Line 1 Fax Number

-N/A- -N/A-
on

n
io

io

io

io

io

io

Address, Line 2 E-Mail Address

at

at

at

at

at

at

-N/A- -N/A-
tr

tr

tr

tr

tr

tr

City
is

is

is

is

is

is

-N/A-
eg

eg

eg

eg

eg

eg

State/Province/Territory

-N/A-
R

R
ity

ity

ity

ity

ity
 R on oo ty at
io Fo lit
eg d R n y

-N/A-
-N/A-
is FD Fa eg od R
tr A FD eg

Country/Area
ci is Fa
ity at
io Fo lit tr A ci is
R n y at
io Fo lit Zip Code (Postal Code)
tr
eg od R n y at
io
is FD Fa eg od R n
tr A ci is FD Fa eg
ity at
io Fo lit tr A ci is FD
R n y at
io Fo lit tr
eg od R n y at
io
is FD Fa eg od R n
tr A ci is FD Fa eg
ity at
io Fo lit tr A ci is FD
R n y at
io Fo lit tr
eg od R n y at
io
is FD Fa eg od R n
tr A ci is FD Fa eg
ity at
io Fo lit tr A ci is FD
R n y at
io Fo lit tr
eg od R n y at
io
is FD Fa eg od R n
tr A ci is FD Fa eg
ity at
io Fo lit tr A ci is FD
R n y at
io Fo lit tr
eg od R n y at
io
is FD Fa eg od R n
tr A ci is FD Fa eg
at tr A is FD
io Fo lit a ci t