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ADMIMSTRATION
Under Chapter 152,Section 25C,SubsecNon 6,the Tovm of Yarmouth is now required to hold issuance or renewal
� of any license or permit to operate a business if a person or company dces 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 INSURANCE 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 customarity 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 tlurty(30)days,and
aa aggregate of not more than ninety(90)days witlun 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,sha(I generally be considered Transient.
POOLS
POOL OPEMNG:All swimming,wading and whirlpools which have been closed for the season must be inspected
by the Health Deparhnent prior to opemng. Contact the Health Department to achedule the inspection three{3)
days prior to opening.PLEASE NOT'E:People are NOT allowed to sit in the pool area until t-he pool has been
inspected and opened.
POOL WATER TESTING: The water must be tested for pseudomonas,tota!coliform and standand plate count
by a State certified lab,and submitted to the Health Deparkment three(3)days prior to opening,and quarterly
thereafter.
POOL CLOSING:Every outdoor in ground swimming pool must be drained or covered within seven('n days of
ciosing.
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 tluce(3)days prior to opening.
CATERING POLICY:
Anyone who caters within the Town of Yarmouth must notify the Yarmouth Health Department by filing tbe
requued Temporary Food Service Application form ?2 hours prior to the catered event. These forms can be .
obtatned at the Health Department,or from the Town's website at www.vazmouth.maus under Health Department,
Dovmloadable 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 Heaith Department. Failure to do so wili result in the suspension or revocation of your Frozen
Dessert Pe�nit until the above tern�s have been met.
OUTSIDE CAF�:S:
Outside cafes(i.e.,outdoor seating with waiter/waitc+ess service),must have prior approva(from the Board of Health.
OUTDOOR COOKING:
Outcloor cooking,preparation,or display of any food product by a retail or food service establishment is prohibited. I
NOTICE:Pernuts run annuatly from January 1 to December 31. IT IS YOUR RESPONSIBII.ITY TO RETURN
TI�COMPLETED RENEWAL APPLICATION(S)AND REQUIRED FEE(S)BY DECEMBER 16,2016.
ALL RENOVATTONS TO ANY FOOD ESTABLISHMENT, MOTEL OR POOL (i.e., PAIIVTING, NEW
EQUIPMENT,ETC.),MUST BE REPORTED TO AND APPROVED BY THE BOARD OF HEALTH PRIOR
TO COMMENCEMENT. RENOVATIONS MAY REQUIRE A STfE PL .
DATE: � (',��'�G SIGNATURE: ��"� �
�+ i
PRINT NAME&TTi'LE: v c�'r4( CI /�'f�h 7 r�q
R�.�oitv�e
I
_Nov. 29, 2C16— 2:35FM N�, 2406 P. 1/1
��ry CERTffICATE OF LIABILITY INSURANCE °"TF`�M'°°'Y"'
� Prtooucert TF{I5 CERTIFICATE IS ISSUED AS A MATTER OF INFORMAT[ON
MCSHEA IN3URANCE AGBNCY INC ONLr qND GONFERS NO RIGHTS UPON THE CER7IFICATE
HOLDER. THIS CERTIFICATE DOES N07 AMENU, EXTEND OR
].550 Falmo�th Rd Ste #2 AL'rER 7HE COVERpGE AFFORDED BY THE POLICI�S BELOw.
C�nterville, MA U263� INSURERSAFFpRdINGCOVERAG6
�resu�eu captain P�rkexa Pub, Inc. iNsuReRn:
668 biain Street �NSURERB: o �_,,� �, S
v�T. Yarmouth, Ma OZG73 INSURER.C:
508-771-4266 INSURERD:
� �� .. IN$U{�ER E: � . �...,.. , .
COVERAGES
THE POLICIES�F INSURANCE USTH�BELOW HAVE BEEAi ISSVED TO THE INSURED Nlr4MED ABOVE FOR THE POLICY PERI
ANY REQU�REMENT,TERM OR CONDITION OF ANY COMTRACT OR OTHER DOCUMEN'1'WI7H R�SPECT TO WMICH 7tiIS CERTIFlCATE MAY eE ISSUED OR
MAY PERTRIN,THE INSURANCE AFFORDFD BY THE P(3UCIE5 DESCRIBE�HEREIN IS SUBJECT TO ALL TIiE TERMS,EXCLUSIONS AtvD C�NUITIONS OF SVCn
POLIC�ES.AGGR.EGATE LIMIT$$HOWN hApY HAVE BEEN REDUCED BY pAl�CLA�MS.
(NSR TypE pF INSURAMCE POLtCY NUM86R POLfCv EFFECTIvE POUCv Exv�Rp,nON �IM�75
GENERAL LI�BILITY EACH OGCURRENCE $
CAMMERCIAL GENERAL UA8ILITY FIRE ppMi4GE(IIMy one�rc) S
�LAIM$MADE �OCCVR MED EXP(Any orre pereon} E � � . .
A 083BANX5037 4J5/2U16 4/5j201.7 �Rsowuapovir.uuRv :
GEMERAIAGGREGA7E 3
�EML AGGREGATE LIra1T qPPUES PER: pItODUCTS-COA9P(OP AGO $
POLICY . �E� 'lOG � � �
AUTOM48116 41ABILtTY
GOMBINEO 91NGLE UMIT $
ANY AUTO �ES 6t�dwNy � .
aL�OwNED AUTOS •
�DIIY INJURY S .
SGHEdUIED AUTOS (Per peraon)
NIREO AUTOS eODILY InuURY
NQN.QWNEDAUTOS (PpaEcideni) $ :
� PI�PERTY OAMAGE S � �
(Per gcddent)
GAqAGE lIAB4�T�' AUTO 6NLY-EA ACCIDENT $
ANY AUTO OTMER TMriN �ACC S
A�1Td ONLY: AGG S . �
EXCESS UABILITY EACH OCCURRENCE S
oCCUR �CtAIM9 MADE AOGREGATE S ;
f '
DEDUCT�BIE S
RETEN710N $ $ .
WORKER9 COMPEN9a1710N AND TORY LIMITS ER
EMPLOYERS'UABRI'tY WCOOC13009 4/1/16 4/1/17
E.L.@ACN ACCIDENT $
A E.�.Di3EA3E•@A EMPl.OyEE S
E.L.OISEASE-Po�icv uMiT S
OTNER
DESCRiPT10N OF OPERAT�OHS(LOCATIO►�S1VEHtCLE61E%CLUS�oN3 AODED 8r ENDORSEMEN�l9PEC��L PRO��g�ONS
CERTIFIGATE HOLDER aoomONAL INSUREo;lNBURER LETIEH: CANC�LLATION
� SHOULD AN�OF TH@ ABOVE DE9CR18ED POLICIEb BE CANCELLED BEFORH TNE ExvIR4710N
TOWS1 o f Yarmouth DATE TNER£OF,T„E ISSUINO INSURHR N�LI ENDE4VOR TO MAIL�_DAYS WRittHN
TOWSl Hd�.l NOT�CE TO TNE CHRTIFICATE MOIDER NAMED TO TNE LEFT,BUT FAILURETp DO SA SHALL
�,icens ing Dept IMPOSe MO OBUGATION OR LIABILITY OF/1NY KINO UPON THE�N$URER.ITS AOENT6 OR
Yarmouth, �da. � 02673 REPRE9ENTA71VB9,
A(RMOR�D R ' �Nk1JlYE�
J�u�
ACORD Z5-S(7197) B ACORD CORPORdT10N 1988