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Home My WebLink AboutApplication and WC � ► TOWN OF YARMOUTH BOARD OF HEALTH �p�� G�G � �' � APPLICATION FOR LICENSE/PE - �`�' �' ��, (,' ��O�5 � �� "`" * Please com lete form and attach all necessary do „ ` ,p��F'� cer�8 X-��U1 S. p Failure to do so will result in the return of �r a ication:;pac1� �`' HEALTH DEPT. ESTABLISHMENT NAME: V S TAX ID: LOCATIONADDRESS: RO o� l� �- (0�73 TEL.#: --`1�1 - 2 MAILING ADDRESS:��' Cv'� �"�,ie IUC tic�0 �A�or��SoCXe� -I- C�8'95 E-MAIL ADDRESS: � � � OWNER NAME: CORPORATION NAME (IF APPLICABLE): CVS PYl�rrrn�°�1 , �-fl C 1VTANAGER'S NAME:S�e..(-�hc�� A��`�C�-QSZ TEL.#: ��7��- �705 MAILING ADDRESS: ' 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 years' records. You must provide new copies and maintain a file at your place of business. 1. 2• 3. 4. FOOD PROTECTION MANAGERS - CERTIFICATIONS: _ __ _ _ __ _ _ -- All food service establishments are required to have at least one fulI-time employee �who is certitied as a �ood - ' Protection Manager, as defined in the State Sanitary Code for Food Service Establishments, 105 CMR 590.000. 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• , PERSON IN CHARGE: - Each food establishment must have at least one Person In Charge (PIC) on site during hours of operation. 1. 2. ALLERGEN CERTIFICATIONS: All food service establishments axe 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-choking 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. L 2. 3. 4. RESTAURANT SEATING: TOTAL# — QFFTf'ii, iT�F QNi Y_� � _—_ ___ __---__ ___. -------- , 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 PERMIT# LICENSE REQUIRED FEE PERMIT# 0-]00 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 ,,n23 —FROZEN DESSERT $40 _TOBACCO $110 NAMECHANGE: $ls . AMOUNT DUE _ $ /$�O.00 ' *****PLEASE TURN OVER AND COMPLETE OTHER SIDE 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 l/ 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. j 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.varmouth.ma.us under Health Department, 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. �I 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 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 REQUIRE A SITE PLAN. DATE: �C�• �' �S SIGNATURE: �, �C� PRINT NAME & TITLE: Donna Chevalier �.icensing Coordinator Rev. 10/O1/15 , ; � � Tke Commonwealth o�Massachusetts De�art,nrent r�f Ir�rfarstrurr�'Accirlents � O,f,�ice af Investigatrrtns ; 6/14 Wushingto�St'�e�et ' �ostvn, hfA 421.I1 I www ma�.g�v/dia Workers' Compegsatian In�ura�ce A.ffid�vi�: Gener�Businesses , ulicant Ir�f'ormatitra Piease Print Le�ibiv CVS/Pharmac� # ( ('J1 '� B�tsi.z2essfOrganizativn Narne:__.__. '1 �dc�e5�: y�g ��e 2�, � City/St�telZip:�.�C+��'Mv�/1.R�—,�C�- �2(�`7 3 Phone#:c5��g= Are you aa empl�yer?Check the��►ropria#e box: Busimess TYP�(x��: 1.� T am a employer with. �C'._employ�es{fi�Il and/ 5- �Reta#I flr pari-t�me)•* 6. ❑ReskaurantlBar/Eatiug Estahlishment 2.❑ I am a sole praprietor ar partncrshzp and have no ?. Q tlffice a�dlor Sale.S(incl.reai estate,auw,etc.) e�npioyees working for�ne in any capacity. [No workexs'cornp.iusutai�ce re;quireclj 8. ❑1�Ton-profit 3.❑ We are a corporation and its offeers h�ve e�cercised 9. ❑Entertainxnent �eir right of exemptic�n per c. 152,§1(�),aud we have i 0,Q Manufacturing no emplayees_(Ns�workers'comp.ins�u�arfce requirerij* 3 L[��Iealth Care 4.❑ t�e are a non-profit orgaztizatiori,si�ffed by vofun�ers, wiih no emglvyees.[No wt�kers'cvmp.inc�►rzzn�e req.] 12.Q t3ther `Aa3'aPPlicant t6ai checks boa-#I must also fiil rnrt the secti�betow showing their wctrkers'compensai�on palicy iaformatinn �:If the eoxporate affice�rss have cxempted themselves,but the cotpc>ration kas other e�npluyees,a workrss'campr�satian poliGy ia required�d svch an axgaaizatmn shouiti checTc hax#1. r� I atn an eenplayer that asprovidxng�vorkers'carnpensation ra�surn!nce for my emptayee�. Belaw is tti�iiepolicy informa�ian. g��C��y��; New Ha.mshire Insurance Company 175 Water Street Insurer's A�idress: New York, NY 10038 CitylState%Zip: WC 9883930 O1/01/2016 Policy#�ar Self-ins.Lic.# E�iration I)a�e: Att�ch a eopy of the wvr�rs'co�qap�ens�tfuu�iey decIarat�crn page(shawiug the poTicy number aati ezp�irar#�ion date). Fai�ure to sec�rre coverage.as re�uired under Section 25A of MGL c. 152 can tead to#he iznpvsition of crimina2 penalries of a fine up to�1,50(I.Oa andlor one-yea�r i�nprisonmen�,as�re12 as civil penalti�s in the farm nf�STt?�'WOR�.4itT3ER and a fins of up to$2SO.t}O a da.y agains#the viola#or. Be ac�vised that a cc3py af this staEsm�zt may be forwarded to the�ffice af Investigations of the I?IA for insurance eaverage v�rification. 1 do h�re ' ,u�der the pains and pe�alti�s of perjury tleat tfie infarma,�inFra,�vaded uibove as�tis und catvEct Si ttue: �a��uc-�-'�.`. Date: ��`L� '�� 401-770- �'1�S Phona#: �czal us�z orily. Da not wr�`e in thxs aren,to be corrrpC�ted 8y etty vT t�iwn,o,/,�'"rc,iat t:l1�T/D3'�(IWII' p'Gt'H1If.�.,ICEAS�� IS8tt1ltg Atlt�l0i`Ity(Cli'CR@ ORg}: �.Soard of Heatth 2.Barttd�ng��partmeat 3.C'itytTown Cterlk 4.Licensing Baard 5.�Selec#u�en's Uf#ice C►.UE�er COI��SL't PEi'SOII' ��pg��; www:rnass,gov/dia i i ' One CVS Drive �� Woonsocket,R!02895 f �f�RrTr ___ _� 'Ci�'�, Jr; � I�, 1S .� ._ � � f: _ � �-��-�-;� ,�;�= - D�ar Sir/�ad��: - Enclose� ple�s� find �omp�etec� app9icatio�a(s� and/o� invoice(s) along with p�y�en� in th� appropria�e amo�ant to co�rer th� cost ��he �2nevval for the CiOS/pharrnacy store(s) in �our area. �lease n�te �ra��ta��a�ra�c�� #��,��'�� r�s�aa��'��traei� r��r�a� ��a��a�r�aai{i�►��r��.s, �r�c��r��s��€�r��er� �rs r�r�flrc�s�r��t��at� �S 931f�%Ce�t�'�0171 �'��A�A�GC��'9�� #dTSEf�� Gflt"��C�'A��'3�'tT�'�'O ��J'#"O�EI S�d'�e Ple�s��nd t�� e�►it��)1��r�� ) a�r��r�f�r��aa��er�eer�a!��ifcaf�orr� fc�s�� s��, �ri�� he s�ore r�urr��a�s�9 �a�a�fe�`t��a�€. �t�� C�``,��►a�, tr��r�se�� 43�p#, l�ail Coe� 'f�fi0, 1�o�ar�s�� Rf ��o After re�esveng the I'ce�ases, @ walB m�ke the ne�essaryr �opies for rr�y f'les �o�d f��+a�d the origina9s t�a the stou-es fo� posting. Ef y�ta have ar�y c��aest�o�s, �le�s� �on��c� m� at�01-770-2278 0� b�r fax�01-652-'�280. Sinc�rel� �€�atna Ctaevalder �icensing Cooe�alinator One Cl/S Drave/A4ai9 Code 1�60 Woonsoc/set, R/0��95 � �S�arrnacy j asaee�rs�rk / �taina�te ci�nic / special�y i '. A!'�� DATE(MM/DD/YYYY) � �� CERTIFICATE OF LIABILITY INSURANCE 1 213 0/20 1 5 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, EXTEMD OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORI2ED 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 NO�NEACT MARSH USA,INC. PHONE FAx 99 HIGH STREET Alc No: BOSTON,MA 02110 pDDR�ESS: Atln:CVSCaremark.CertRequest@marsh.com Fax:212-948-5338 INSURER S AFFORDING COVERAGE NAIC# S02406-ALL-GAW-16-17 iNsuRER A:New Hampshire Insurance 23841 INSURED INSURER B:N8SOf181 UI110I1 FIfE:II1S CO ttsburg 19445 CVS HEALTH CORPORATION ONE CVS DRNE,MC 2180 INSURER C: 4£ '` WOONSOCKET,RI 02895 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: NYC-007875800-22 REVISION NUMBER:1 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTIMTHSTANDING 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 'rypE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DD/YYYY MM/DD/YYYY A X COMMERCIAL GENERAL LIABILITY GL 2039188 O1IO1/2016 O1/01/2017 EACH OCCURRENCE $ 4,500,000 CLAIMS-MADE �OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ 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 $ INCLUDED OTHER: $ B AUTOMOBILE LIABILfrv 9734291(AOS) 01/01/2016 01/01/2017 COMBINED SINGLE LIMIT g 1,000,000 Ea accident B x ANY AUTO 9734292(VA) 01/01/2016 01/01/2017 BODILY INJURY(Per person) $ g ALL ONMED SCHEDULED g7342g3(MA) 01/01/2016 01/01/2017 BODILY INJURY(Per acciderrt) $ AUTOS AUTOS x HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident SELF-INSURED PHY.DMG. $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION See Page Two for Policy Numbers 01/01I2016 �1/�1/2�1� X STATUTE ERH AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y�N E.L.EACH ACCIDENT $ 2,000,000 OFFICER/MEMBER EXCLUDED? � N�A ' (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 2,000,000 If yes,describe under 2,OOU,UqU DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS!VEHICLES(ACORD 101,Addttional 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 RE�UIRED UNDER THE LEASE OF THE PREMISES OR UNDER ANY OTHER WRITTEN CONTRACT OR AGREEMENT. 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 AU7HORI2ED REPRESENTATIVE of Marsh USA Inc. Yevgeniya Muyamina ��+�;��x., I?Z�.air,xc,ncs, OO 1988-2014 ACORD CORPORATION. All rights reserved. ; ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD , , I I AGENCY CUSTOMER ID: S02406 LOC#: Boston ''�� A�!�D ADDITIONAL REMARKS SCHEDULE Page 2 of 3 AGENCY NAMEDINSURED MARSH USA,INC. CVS HEALTH CORPORATION ONE CVS DRIVE,MC 2180 POLICY NUMBER WOONSOCKET,RI 02895 CARRIER NAIC CODE EFPECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Cert�cate of Liability Insurance WORKERS COMPENSATION DEDUCTIBLE PROGRAM: POLICY DATES:JAN 1,2016 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,WV A 066830240(PA) PA A 066830238(ME) ME A O6S830242(TY,; 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 Compensa6on Self-Insured RetenGons: DC,MA,OH,RI: $500,000 CT,NC,NJ,VA: $1,000,000 COVERAGE A:Workers Compensation:Staturory COVERAGE B:Employers Liability Limits:$500,OOOl$500,000�500,000 AUTO POLICY NUMBERS FOR OMNICARE,INC.AND OMNICARE,INC.ENTITIES EFFECTIVE 1I112016: POLICY:3434109(AOS) CARRIER:NATIONAL UNION FIRE INSURANCE COMPANY DATES: tI112016-11112D17 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: 1l1/2016-1/1/2017 ACORD 101 (2008/01) O 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMERID: S02406 LOC#: Boston A�� ADDITIONAL REMARKS SCHEDULE Page 3 of 3 �..-�. 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: Cert�cate of Liability Insurance 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 before the effec6ve date of cancellation if we cancel for non payment of premium 1)General Liability Addi6onal Insured-Where Required Under Contract or Agreement language per endorsement 61712(12I06): SECTION II-WHO IS AN INSURED,is amended to include as an additional insured: Any person or organization to whom you become obligated to include as an addi6onal insured under this policy,as a result of any contract or agreement you enter inlo which requires you to furnish insurance to that person or organizffiion of the type provided by this 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 an/or iimits of this policy,or �The coverage andlor limits required by said conhact or agreement. 2)General Liability Eadier Notice of Cancellation Provided By Us ianguage per endorsement CG 02 2410 93: Number of Gays•'Notice 9u For any stffiutorily 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. 3)General Liability Advance of Cancella6on to Enlities Other The Named Insured Limited to E-Mail Notfication per Chartis Manuscript endorsement: In the event that the Insurer cancels this 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"certificate Holder(s)");and has provided to the Insurer,either directly or through its broker of record,the email address of the contact at such entiry, and the Insurer received this information afler the First Named Insured received notice of cancella6on of this policy and prior to this policy's cancellation effective date,via an electronic spreadsheet that is acceptable to the Insurer, ihe Insurer will provide advice of cancella6on(the"Advice")via e-mail to such Certfficate Holders. Proof of the Insurer emailing the Advice,using the infortnaGon provided under this policy by the First Named Insured,will serve as proof that the Insurer has fully satisfied its obligations under this endorsement This endorsement dces not affect,in any way,coverage provided under this policy or ihe pncellation 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 Definitrons appiy to ihis endorsement: 1.First Named Insured means the Nart�ed Insured shown on the Declarations Page of this policy. 2.Insurer means the insurance company shown in the header on the Declarations Page of this policy. All other terms,crondilions 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