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Home My WebLink AboutApplication and WC _ .� • �� TOWN OF YARMOUTH BOARD OF HEALTH � j`��L �° �� APPLICATION FOR LICENSE/PER11�� 2 �g F;�G� �7�� : ``" * Please complete form and attach all necessary docu�en � cembe .:�5 2015. � Failure to do so will result in the return of your ap ieation pack : HEALTH DEPT. ESTABLISHMENT NAME: �V h�t ��-( TAX ID: LOCATION ADDRESS: ��"-✓ Srxti�tlo�.► A�� S`( ��-bb`t TEL.#: 5b�'f- ��48�—O�Z(�r MAILING ADDRESS:c')�(1� C� )S �r�J� /l.�C' I l�00 C��('��D ( 1LeiF �3 02�9 S E-MAIL ADDRESS: � OWNER NAME: �,�.,.5 I�Q��( '�C' CORPORATION NAME (IF APPLICABLE): � C� MANAGER'S NAME:��Q 1n i a C�C�a TEL.#: 5b�_ a��-�7 6Sc�- I M�AILING ADDRESS: � � � � r POOL CERTIFICATIONS: The pool supervisor must be certified as a Pool Operator,as required by State law. Please list the designated Pool Operator(s) and attach a copy of the certification to this form. 1. 2• Pool operators must list a minimum of two employees currently certified in standard First Aid and Community � Cardiopulmonary Resuscitation (CPR), having one certified employee on premises at all times. Please list the � employees below and attach copies of their certifications to this form. The Health Department will not use past i years' records. You must provide new copies and maintain a file at your place of business. 1., 2• 3. 4• F�J�JL� PROT-ECTION�4ANAGERC - C�RTIFICATi(�NS: __ . _ _ __ _ � All food service establishments are required to have at least one full-time employee who is certified as a Food � Protection Manager, as defined in the State Sanitary Code for Food Service Establishments, 105 CMR 590.000. I Please attach copies of certification to this application. The Health Department will not use past years'records. ! You must provide new copies and maintain a file at your establishment. i I 1. 2. i i PERSON 1N CHARGE: Each food establishment must have at least one Person In Charge (PIC) on site during hours of operation. I i 1. 2• i ; ALLERGEN CERTIFICATIONS:• � All food service establishments are required to have at least one full-time employee who has Allergen certification, ', as defined in the State Sanitary Code for Food Service Establishments, 105 CMR 590.009(G)(3)(a). Please attach copies of certification to this application. The Health Department will not use past years' records. You must provide new copies and maintain a file at your establishment. 1. 2• HEIMLICH CERTIFICATIONS: � All food service establishments with 25 seats or more must have at least one employee trained in the Heimlich ; Maneuver on the premises at all times. Please list your employees trained in anti-chokmg procedures below and attach copies of employee certifications to this form. The Health Department will not use past years' records. ; You must provide new copies and maintain a file at your place of business. ' 1. 2• 3. 4• RESTAURANT SEATING: TOTAL# -- -- —______ n--�s'i!�-�CT (1Ni� _ ; LODGING: LICENSE REQUIRED FEE PERMIT# LICENSE REQUIRED FEE PERMIT# LICENSE REQUIRED FEE PERMIT# B&B $55 CABIN $55 _MOTEL $110 ' �iNN $55 CAMP $55 _SWIMMING POOL$110ea. LODGE $55 TRAILER PARK $105 _WHIRLPOOL $110ea. FOOD SERVICE: LICENSE REQUIRED FEE PERMIT# LICENSE REQUIRED FEE PERM[T# LICENSE REQUIRED FEE PERMIT# 0-100 SEATS $125 _CONTINENTAL $35 NON-PROFIT $30 >100 SEATS $200 COMMON VIC. $60 WHOLESALE $80 — — —RESID.KITCHEN $80 RETAIL SERVICE: LICENSE REQUIRED FEE PERMIT# LICENSE REQUIRED FEE PERMIT# LICENSE REQUIRED FEE PERMIT# <50 sq.ft. $50 >25,000 sq.ft. $285 VENDING-FOOD $25 �<25,000 sq.ft. $150 6-O 2 _FROZEN DESSERT $40 TOBACCO $110 ; NAME CHANGE: $ls AMOUNT DUE _ $ /Sb•O Q ' *****PLEASE TURN OVER AND COMPLETE OTHERSIDE OF FORM***** � ADMINISTRATION ; Under Chapter 152,Section 25C,Subsection 6,the Town of Yarmouth is now required to hold issuance or renewal ! of any license or permit to operate a business if a person or company does not have a Certificate of Worker's Compensation Insurance. THE ATTACHED STATE WORKER'S COMPENSATION INSURANCE AFFIDAVIT MUST BE COMPLETED AND SIGNED, OR � � � CERT. OF 1NSURANCE ATTACHED ; OR �' WORKER'S COMP. AFFIDAVIT SIGNED AND ATTACHED Town of Yarmouth taxes and liens must be paid prior to renewal or issuance of your permits. PLEASE CHECK APPROPRIATELY IF PAID: � YES NO �� MOTELS AND OTHER LODGING ESTABLISHMENTS TRANSIENT OCCUPANCY: For purposes of the limitations of Motel or Hotel use,Transient occupancy shall be limited to the temporary and short term occupancy,ordinarily and customarily associated with motel and hotel use. Transient occupants must have and be able to demonstrate that they maintain a principal place of residence ; elsewhere.Transient occupancy shall generally refer to continuous occupancy of not more than thirty(30)days,and an aggregate of not more than ninety(90)days within any six(6)month period. Use of a guest unit as a residence or dwelling unit shall not be considered transient. Occupancy that is subject to the collection of Room Occupancy Excise, as defined in M.G.L. c. 64G or 830 CMR 64G, as amended, shall generally be considered Transient. � POOLS ; , _ _, , .. __:_� _ POOL OPENING:All swimming,wading and whirlpools which have been closed for the season must be inspected by the Health Department prior to opening. Contact the Health Department to schedule the inspection three(3) days prior to opening. PLEASE NOTE: People are NOT allowed to sit in the pool area until the pool has been inspected and opened. POOL WATER TESTING: The water must be tested for pseudomonas,total coliform and standard plate count by a State certified lab, and submitted to the Health Department three (3) days prior to opening, and quarterly thereafter. POOL CLOSING: Every outdoor in ground swimming pool must be drained or covered within seven(7)days of closing. FOOD SERVICE SEASONAL FOOD SERVICE OPENING: All food service establishments must be inspected by the Health Department prior to opening. Please contact the Health Department to schedule the inspection three (3)days prior to opening. CATERING POLICY: Anyone who caters within the Town of Yarmouth must notify the Yarmouth Health Department by filing the required Temporary Food Service Application form 72 hours prior to the catered event. These forms can be obtained at the Health Department,or from the Town's website at www.yarmouth.ma.us under Health Deparirnent, Downloadable Forms. FROZEN DESSERTS: Frozen desserts must be tested by a State certified lab prior to opening and monthly thereafter,with sample results submitted to the Health Department. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms have been met. OUTSIDE CAFES: Outside cafes(i.e.,outdoor seating with waiter/waitress service),must have prior approval from the Board of Health. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a retail or food service establishment is prohibited. NOTICE: Permits run annually from January 1 to December 31. IT IS YOUR RESPONSIBILITY TO RETURN I, THE COMPLETED RENEWAL APPLICATION(S)AND REQUIRED FEE(S) BY DECEMBER 15, 2015. '� ALL RENOVATIONS TO ANY FOOD ESTABLISHMENT, MOTEL OR POOL (i.e., PAINTING, NEW EQUIPMENT, ETC.), MUST BE REPORTED TO AND APPROVED BY THE BOARD OF HEALTH PRIOR TO COMMENCEMENT. RENOVATIONS MA UIRE A SITE PLAN. `� . �s �� I DATE: �,Z~ 1 SIGNATURE: r�_ ; PRINT NAME & TITLE: Donna Chevalier � icensing Coordinator ` Rev. 10/O 1/I S i � � � � The Commonweallh o,f Nlassachusetts Department of Industrial Accade�tts Office af Inves�igations 60D Wttshing�on Street .8vstvn,MA �21�1 www.mass.gc�v/daa Work�rs' Comgensation Insurance Affidavit: Ceneral Businesses Ap�licant Informatian Please Prin#Le�ibiv CVS/Pharmacy # a�� Busixr.essl4rganizatior�l�tame:_____ Addre�s:_��bs S-�c1�i�� t�� City/St�.te/Zip��l�� ya� �.-/�q- C�(o(a�{Phone#: �f��- ��- �2-cd Are yon an employer?Cl�eck tite agpropriate bax: Business Type(re�ired): �� 1.� T am a employer with aJ emgl+oyeas{fuil and/ 5. �Retail or gart-time}.* b. ❑Restaurantt�tarlEating Estatslisttment . � 2.❑ I am a sote proprietor ar partncrship atid have no �. ❑t}ffice andlor Sa1.es{incl.real estate,auto,etc.} � em�rFoyees working for r�e in any capacity. ? 8. ❑Non-profit [No warkers' comp.insurance required] ': 3.0 We are a corporatian and its officers have e7cercised 9. ❑Entertainment j �heir right of exempt�on ger c. 152,§1(43,and we have 10,[�NGanufacturiag � no emplayees_[T�o workers'comp.insura�ce requirerI]* 4.Q t�Je are a non-pmfit organization,staffed by volunteers, 11.[]I3ealt3�Care wi#h na ernglayees.[No warkers'cou�p.insuranee req.] 12.[]t3ther "At�y applicant that checks box#1 must also fitl art the sxtioa 6�Iow shoiving iheir worket's'r.ompensatian palicy infbzmation. *sIf the corparate offieers have exempted tbemselves,but the corporation has other ernptayees,a workers'corrYpensaaan policy is-�c{uired and snah an arganiz�tion shou3d che�k box#i. I aix a��employer fhat as prvvrdirtg workers'caxnpensatta�r B�ssurance for my emplaye�s. Beiow r's 13he palicy infornia�iori. � Ynsurance Company Name: New Hamshire Insurance Company 175 Water Street � Insurer's Address_ New York, NY 10038 j City/StatelZip: l WC 9883930 01/O1/2016 � �'olicy#�ar Self-ins.Lic.# E7cpiraxion Dater � � � I Attach a eopy af�he wor�cers'eompenxatEon Palic3'decIar�iion.page(shavri�g the putiey number aHd eapixatia�dade): Failure to secure coverags as r�quired under Section 2�A of MGL c. 152 can lead to the imposi�ian of criminal penalties of a fine up to$1,500.00 and/or nne-year irmpri��ent�as s�vell as civil penaldes in the fa�€n of a STUP WOR�.ORDER and a fane of up to�2SO,OQ a day agains#t�e viQlator. Be ad�iised that a copy of this sta.ternent may be forwarded to the C3ffice of Investigations of the DTA for in�,tr�,nce eoverage veri�cation. : 1'dv hereby rt#ffy,u�der#he pains a�ad�ena&ies of perjury Zhat t�re infvrmatavr�pravided ahove is true aKd corr�c� ��;�ature• c��-a. �„,�,�� Date: 1�.� ��/S` 401-770- d�'1� Phone#: tl„�`sial use c►n�y. ,�3o not wri#e us tkis arerr,to be corrrpC�terl hy cety or tv�vn�'"rcia� City�e�Town: Permitll�icense# � Issuing Anthority(cirete oue}: 1,Soard of Heaitta 2.8e�fidz"ng�epartment 3.C'ityfT€�wn�Cterk 4.Licsn�ing Board 5.Selecimerc's Ofiice 6.Utlaer � Cv�tact Persoa: Ph�ne#; ? www:mess.govidia 1 � t One CVS Drive �� Woonsocket, RI 02895 -- � I C;,��nR�� ; r� � �!, � � � � ' � ._ __ �v � ;�� s-�i�� •��- i _ _ ,. � _�_ ___ - ; Dear Sir/�ad��: � i i �ncBosed please fand �o�pietecf applacata�r�(�� a�adfc�r onvoi�e(s) alon� wi4h p�yr�ent i� th� a�pro�ria�e amount to couer the cost o�the renevv�9 for�he CiiS/phars�acy sfore(s) i� �our area. �iea�� a�te a��f��a��a��c��f��i��s�� r�s�aa•ai'��a rra��a�e��r�a�ili� ��r�ss �r�c�tr�c��°��r��r� ��s r�r��r+��s�r�� S �d7C�fC��'�C�Oi� �'�£a�A��IC��'�0�2 �� l9TS�#�°� �flt"1"�'C�'A��i'Fi'E�IT�'�8 �f��A�"0�3@f`S��"�. j f'�e�s�s�nd th��rrrif�s�I��r��(�) ��f��s�r��rai a��lica��o�� fc�� ; ��'OF�9 9!�%��T f�iE S�Or�TBl[Pti�B@t'��gcg l� d�'Tl��'TN�1�,f6�� i?� C��'f��s �F��€�sf_i�' � �3��f, l�ail �o� �d'f�0, �oc�r�s�� ! �2�9�e After receiving the 9'censes, I wal9 � rro�ke the necessa�r copses for my files ��ad forv�ard �he �rAginals tm �he storss fo� � postirtg. i i ; 6f you have ar�y questao�as, p0ease cor��act rne at�01-770-2278 or b�fax��1-652-�2�0. Ser�cerelg� � E � � D�nna Ctrer�a9eer � Licee�sirag Coordina�vr ` �91� ��$�C6V�✓��1��OC�� '��SO , �oo„socker, ��o2�s5 ; �s �S6�ae�a�a,�y j �aremaric / minute c9inic J special��r � '`�coR � CERTIFICATE OF LIABILITY INSURANCE DATE�MM/DD/YYYY) �,,,.��" 12/30/2015 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 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 endorsement(s�. PRODUCER CONTACT MARSH USA,INC. NAME: 99 HIGH STREET PHONNo Fa�c No: BOSTON,MA 02110 pDDR�ESS: • Altn:CVSCaremark.CertRequest@marsh.com Fax.212-948-5338 INSURER S AFFORDING COVERAGE NAIC# S02406-ALL-GAW-16-17 �NsuRER q:New Hampshire Insurance 23841 INSURED INSURER B:N8b0l181 Uf110f1 FfB If1S CO ttsburg 19445 CVS HEALTH CORPORATION ONE CVS DRIVE,MC 2180 iNsuRert c: s`t " WOONSOCKET,RI 02895 INSURER D: INSURER E: � INSURER F: COVERAGES CERTIFICATE NUMBER: NYc-oo7a75aoa22 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, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TypE OF INSURANCE ADDL SUBR POUCY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DD/YYYY MM/DD/YYYY A X COMMERCIA�GENERAL LIABILITY GL 2039188 01/01/2016 01(O1/2017 EACH OCCURRENCE $ 4,500,000 CLAIMS-MADE �OCCUR DAMAGE T RENTED PREMISES Ea occuRence $ 1,000,000 X SIR: $500,000 MED EXP(Any one person) $ X LIQUOR LIABILITY INCLUDED PERSONAL&ADV INJURY $ 4,500,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 28,000,000 X POLICY❑PRO- ❑ JECT LOC PRODUCTS-COMP/OPAGG S INCLUDED OTHER: S B AUTOMOBILE LIABILITY 9734291(AOS) O1/O1I2016 01/01/2017 COMBINED SINGLE LIMIT g 1,000,000 Ea accident B X .4NY AUTO 9734292(VA) 01/Ol/2016 01/01/2017 BODILY INJURY(Per person) $ g AlL OWNED SCHEDULED y73¢ZJ3�Mp� 01/01/2016 01/01/2017 BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident SELF-INSURED PHY.DMG. g UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION See Page Two for Policy Numbers 01/01/2016 01/01/2017 X PER OTH- AND EMPLOYERS'LIABILITY Y�N STATUTE ER P,NY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 2,000,000 OFFICER/MEMBER EXCLUDED? � N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 2,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 2,000,000 DESCRIPTtON OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,AddRional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER IS NAMED AS AN ADDITIONAL INSURED AS THEIR INTERESTS MAY APPEAR,AS RESPECTS THE LEASED PREMISES,BUT ONLY TO THE EXTENT REQUIRED UNDER THE LEASE OF THE PREMISES OR UNDER ANY OTHER WRfTTEN CONTRACT OR A�REEMENT. VARIOUS LOCATIONS,STORE#161, 735&944. CERTIFICATE HOLDER CANCELLATION THE TOWN OF YARMOUTH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ATTN:BRUCE MURPHY THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN BOARD OF HEALTH ACCORDANCE WITH THE POLICY PROVISIONS. 1146 ROUTE 28 SOUTH YARMOUTH,MA 02664 AU7HORRED REPRESENTATIVE of Marsh USA Inc. Yevgeniya Muyamina ��;�o� /?Zt�wirs+e.n.aE �O 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: S02406 LOC#: Boston AC�� ADDITIONAL REMARKS SCHEDULE Page 2 of s �� AGENCY � NAMEDINSURED � MARSH USA,INC. CVS HEALTH CORPORATION i ONE CVS DRIVE,MC 2180 ! POLICY NUMBER WOONSOCKET,RI 02895 � CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: _Certificate of Liability Insurance WORKERS COMPENSATION DEDUCTIBLE PROGRAM: POLICY DATES:JAN t,2016 TO JAN 1,2017 Ins.Co. Policy# States Covered A 066830239(MN) MN A 066830241 ND,WA,WI,WY A 066830236(FL) FL A 066830235(CA) CA A 066830237 IL,KY,NH,UT,VT A 066830234(AZ) AZ A 066830233(AOS)AL,AR,CO3 DE,GA,HI,IA,ID,IN,KS,LA,MD,MI,M0,MS,MT,NE,NM,NV,NY,OK,OR,SC,SD,TN,VW A 066830240(PA) PA A 066830238(ME) ME A O6o830242(TX; TX EXCESS WORKERS COMPENSATION PROGRAM POLICY DATES:JAN 1,2016 TO JAN 1,2017 B 1103547 DC,MA,OH,RI B 1103546 CT,NC,NJ,VA Excess Workers Compensation Self-Insured Retentions: OC,MA,OH,RI: $500,000 CT,NC,NJ,VA: $1,000,000 COVERAGE A:Workers Compensation:Statutory COVER4GE B:Employers Liability Limits:$500,000/$500,OOOl$500,000 AUTO POLICY NUMBERS FOR OMNICARE,INC.AND OMNICARE,INC.ENTITIES EFFECTIVE 111/2016: POLICY:3434109(AOS) CARRIER:NATIONAL UNION FIRE INSURANCE COMPANY DATES: 111I2016-1I112017 POLICY:3434110(VA) CARRIER:NATIONAL UNION FIRE INSURANCE COMPANY DATES: 1/1/2016-1/1/2017 POLICY:3434111(MA) CARRIER:NATIONAL UNION FIRE INSURANCE COMPANY DATES: 1I112016-1I112017 ACORD 101 (2008f01) �O 2008 ACORD CORPORATION. Ail rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMERID: S02406 ' LOC#: Boston ACO� ADDITIONAL REMARKS SCHEDULE Page 3 of s �._.---. AGENCY NAMEDINSURED MARSH USA,INC. CVS HEALTH CORPORATION ONE CVS DRIVE,MC 2180 POLICY NUMBER WOONSOCKET,RI 02895 � CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance � I COMMON POLICY CONDITIONS A.Cancellation � 2.We[Carrier]may cancel this policy by mailing or delivery to the first Named Insured written notice of cancellation at least: a.10 days befo2 the effective date of cancellation if we cancel for non payment of premium 1)General Liability Additional Insured-Where Required Under Contract or Agreement ianguage per endorsement 61712(12106): SECTION II-WHO IS AN INSURED,is amended to include as an additionai insured: Any person or organization to whom you become obligated to include as an additional insured under this policy,as a result of any conhacf or agreement you enter into which requires you to furnish insurance to that person or organ¢ation of the type provided by ihis policy,but only with respect to liability arising out of your operations or premises owned by or rented to you. However,the insurance provided will not exceed the lesser of: •The coverage anlor limits of this policy,or � •The coverage andlor limits required by said contract or agreement. � 2)General Liability Eadier Notice of Cancellation Provided By Us language per endorserr�nt CG 02 2410 93: Number of uays•'Notice 9u For any statutorily permitted reason other than nonpayment of premium,the number of days required for notice of cancellation,as provided in paragraph 2.of either the CANCELLATION Common Policy Condition or as amended by an applicable state cancellation endorsement,is increased to the number of days shown in the Schedule above. 3j General Liability Advance of Cancellation to EnliGes Other The Named Insured Limited to E-Mail Notificafion per Chartis Manuscript endorsement: In the event that the Insurer canceis Ihis policy for any reason other than non payment of premium,and 1. The cancellation effective date is prior to this policy's expiration date; 2. The First Named Insured is under an existing contractual obligation to no6fy a certificate holder when this policy is cancelled(hereinafter,the"cerfificate Holder(s)");and has provided to the Insurer,either direcGy or through its broker of record,the email address of the crontact at such entity, and the Insurer received this informatan after the Firsi Named Insured received notice of cancellation of this policy and prior to this policy's canceliation effective date,via an electronic spreadshcet that is acceptab�to the Insurer, the insurer will provide advice of cancellaGon(the°Advice°)via e-mail to such Cert�cate Holders. Proof of the Insurer emailing the Advice,using the informa6on provided under this policy by the First Named Insured,will serve as proof that the Insurer has fully satisfied its obligations under ihis endorsement. This endorsertient dces not affect,in any way,coverage provided under this policy or the cancella6on of this policy or the effective date thereof,nor shall this endorsement invest any rights in any entity not insured under this policy. The following DefiniGons apply to this endorsement: t.First Named Insured means the Named Insured shown on the Declarations Page of this policy. 2.Insurer means the insurance company shown in the header on ihe Declarations Page of this policy. NI other terms,conditions and exclusions shall remain the same. ACORD 101 (2008/01) O 2008 ACORD CORPORATION. All rights reserved. ' The ACORD name and logo are registered marks of ACORD i