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Home My WebLink AboutCertifications .- f � .� ! ' r��:.��'��::� , SOLITH YARMOLITH .,,�?� � � zpt7 LINITED METHODIST CHLIRC HEALTH DEPT. Reverend Ernest R. Belisle, Pastor ��`� � . €, ... luly 13, 2017 ��.y ' ` "' ., `Ibt9f1 �`��ir.° •��4 Mr. Philip Renaud Health Inspector Town of Yarmouth s 1146 Route 28 S.Yarmouth, MA 02664 Dear Mr. Renaud, � Enclosed please find our 2017 Non-Profit Food Service Application and a check for$30. The following i documentation is also included: ' ; Certificate of Workers Compensation and Employers' Liability Insurance ; ServSafe Training Connie Swedlund Expires 06/2022 Certificates of Allergen Awareness Training Ruby Ackert-Herzig Expires 06/2022 Connie Swedlund Expires 07/2022 First Aid CPR AED Certificates(includes Heimlich training) � Sandra 1. Duncan Expires 02/2018 Joanna Lovely Expires 04/2018 Allan F. Lovely Also Massachusetts Dept.of Public Health EMT Basic Training Expires 04/2018 ; PEARS Provider Expires 02/2019 ' Chris Dickey Expires 12/2018 Also Administering Emergency Oxygen &Waterfront Skills& Lifeguarding Ruby Ackert-Herzig Expires 06/2019 i Joshua F. Lovely Expires 06/2019 Harriet Murphy Expires 06/2019 Don Ellicott Expires 06/2019 j John Duncan Expires 01/2020 � Please let me know if you need any further information. ' Sincerely, ' � �C�'��,`�c"'�'�.-4�1.�`� � i Ruby P.Ackert-Herzig, Secretary • ' Email: syumc.secretary@verizon.net � Summer Office Hours: Tuesday—Thursday 9 to 2 324 Old Main Street,South Yarmouth, MA 02664 � Telephone: 508.398.9482 Fax: 508.398.2972 % ; www.syumc.org � Email: s.yarmouthumc@verizon.net 1 � `,� � ,�� . - ��FOO�S� ' NATIONAL REGISTRY OF ; �4 �',�, FOOD SAFETY PROFESSIONALS� �. ,� � �� ' � � CERT[FIE8 � s � CONNIE SWEDLUND `= HAS SUCCESSFULLY SATISFIED THE REQUIREMENTS FOR THE ' , �r, FOOD SAFETY MANAGER � "�"� UNDER THE t� �� ` `� CONFERENCE FOR FOOD PROTECTION STANDARDS '�-`,�_ �u._��' � � ;� � ,, .� _- � ;�f'� � � PRE5(DENT: �I� __= LawRENCE J.LYNCH,CAE � � , � � � ISSUE DATE:JuNE 19, 2017 � EXPIRATION DATE:JUNE 19, 2022 � sabsb CERTIFICATE NO: 21 361697 751 Forum Drive,Suite 220,Orlandq FL 32821 TEST FoRn�: EXE67 i00}446-0257 F(407)352-3603 wwwNRFSP.com This certificate is not valid for more than five years Gam date of issue. vational Registry of Food Safety Professionals' j �� CERTIFICATE OF ALLERGEN AWARENESS TRAINING Name of R�cipleilr_Ruev:nc�Rr-Heazic � � Certificate l�iurrtber: Z98as� Date of Completion: �"�" Date of F.zpiratton'��s"gn0� `� � � � � i�,.�a sy: ?he above-named�ierson is hereby issued this cert�rate �� -- or com letin an aller en awareneu trainin ro am [�tATIONAL � I P 8 8 gp S' � � RESTAURANT reco�nixed by the Massachusetts Department of Publit Health __ �... ASSOCIA?ION� ' in accordance with 105 CMR 590.009(GJ(3J(a). Massachusetcs Ressaurant Association 800.765.2122 333 Turnpike Road,Suite 102 www.resraurantorg So�chborough,n�n oinz 7l,ris certi�cate wil!be valid for f'zve(SJ years from date of rompletion. 508-303-9905 www.marestaurxntassoc.org �� .. ,��.� T , \/�' . . t . �\/jt, . .f,� �� [�/�, . ?: . ,�� `� .. �+ . �� ,. t y. .-�C' � �r.X:-C � 'J-��..-c.' � �.��:�C � -.T,Y,R" j� '�,.n ,s. n . . .,f .. , n ,, , - , n , � ,. _ ,. , , n � t � , , n . , , , , � `' '�i�`�c��..%�`~c�:�:�-��c�:e.��'c�.e.�i��c��' ''��fr �� ,. _ ;�� .�- o a _x� + :��jl�� ti ��'+ ; G1�y��=, !n � '�r�i''4:�_ • = n.; _ ❑ ❑ - `�� ,: � • - ' ' �Y �C�. ► _ � �,�� . , ��. 1' r '� � � . � v�-� �� :-r3��n _ i ; n4� � •��,Y� " � - � ; � Yr �+'K�2� � •r�� .;�� -�. ;�i,, � . �a ;-r'3�H�� v�"�-�-. <� �` n; . �C,:� � ' = �:�>� ��, , . _ ,� _ , , �1: . :-.��l� : � Vt��•-: �n : _ �; � . . : �Y �' ; _ , . . . = , '' �y �.,c�� _ . � .�>� • .!� , � _ �_ . _. . . . _ :.��v � � • � �'' = uc��.; � � � : c�-- �:n = - � > • � � � � � , , _ . _ , � �'� C�:� - � � � : �-.,} �f , : _ , �i, � � t '� ;'�� . • � - V/�.;�� ;�'� . � - � 1•�'. p. 1 ^ • ` l� ..+��\� r �Ci:► � : �;'>�``I"' •�� ` - � t� �!'�� ' � � l ' ,-��,:�V : `� ' ��-��.�. e� _ � �'f � 1 ' • �C�. :. �� ,w� .�. �}�� !' � .�JiC��.��Jft.��J�.t.�.�J.�C��:.�J.wC��, �1 t�� U, i s :� U i' - "� U i: � ,U i � U i� � `� a.��-c. � r �. t� r �-�: t� :� � t� r �. � ar � '� r�� f: �� , r�� r�� ,1; �� f: �� H�a I t h c a r e � �g�can T`�"""� Safety Program Consultan�s�nc MA4688 Heart ��Name ____ _ P r a v i d�r Assoc+atwn3 TC PO Box 259 Rehoboth M!{42769 _,_.�,. Inta wwrn.4spci.com 508-252•3049 PEEL --- ------.____.__. co�rse . HERE Sandra J Duncan L«�c�on Hyannis MA --+. ---- ------ ------ -- _— This card cerfifies that the above individuel has Succes.�^fully Mskrucior Inst 10# comptetesi the cognitive and skiits evaluatiorts in accorcfance vrith N�„e Ailan Lovely Q51 AQ24$359 itte cucriculum of the American Heart Association BLS tor Heaithcare ----- — � Providers{CPR ar�AEU?Program. yolder's 2/03/2016 2/0312048 s�gnamre_ __ __ fssue 6ate Recommer�ded Renewa!Oate� o2et�a�Nesc as�aaason rsaca:y w�,aa u�d ws�ae.,r m arwmran.-v. 9c.ie�� This card contains unique security features to protect against forgery. 9p-t80t 3/tt i MEARYSAYER CPR AED HEARTSAYER CPR AED � Meartsaver° � American cenier Name'E.M.E./CommouFiealth CPI��A20277 � �R R ��D Heart - . � Association, TC 326 Saatuit Newtown Road,Marstons Mi1ls,MA 02348 j --� Info � HERE JOSHUA F.LOVELY �� Wellfleet Blementary Schaol ' Locatior, --� -----------_.-- -._��.----—._--------.—. .�___—_-- — Tne atnve individuat tms wCceSsiWN comPleted the objectfves and Sw71s evaivations i � �,a��u,��mm m�arw�r��ca�r�o v�m,o�ai �am,cto, Al lan Lavely 0514024��5�� I �mpteted modWes are those NOT�rcarkked aR: _________._ ______________ ObiQ�� ima�,�cv� 0�?19 Hoia��5 s;gnature -- _ _—�----- — — --------__.—,—_�..T�._ . LssueJate FtecemmendedRenewral0ate &Ze�s�anx+c.nr�tn�sacaticn rar�e;viyw�rtnscca�aw,xastv2sa�rmce. �5-reia � . . _ __._. _._.__� __ .__ _. i . � ---.. __... i ' Strike through the madules NdF completed. ' � This card contains unique securiry features to protect against forgery. �;-�Sio 2ns ( _._.___. ___.___ _______._._ ___ _. ___ _ _. �i_ � BASfC LI � E SUPPtiRT BASIG LtFE SU � PpRT B/ '�+ �S T��"s Safety Program Consultant�t�MA4688 L�-� American Center IVame iProvider Heart P Box 259 Rehobath(N�02769vi -� Association� TC ""i" Inio www_4spci.com 508-252-3049 i'EEL —_._.___---- ttERE Joanna Lovely �a„ Provincetawn _..s. -----____ __ The above indrvid�l has successtu[!y cornpleted the cognitive and �nstroctar T� nst.ID# skitls evalua8ons in accnrdance witt�thc,curricvlum ot the Amarican p��e AI{an Lovely 051402�$35� H�rt Associaaon Basic Life S��rt(CPR and AEQ1 Prcgram. -------__�__�__� � 4/10l2016 4/10/2018 Haa��$ ____ su3nature Issue Qate Recommended Renewai f7ate �2a�s nmax.a��.�socaw�, rr.�wan nas ranr war atnr r�c�. is,eos . ��' 'Fhis card contains unique security features to protect against fargery, 15-1805 1t/15 MASSACHUSETTS OFFICE OF EMERGENCY MEDICAL SERVICES DEPAR7MENT OF PUBLIC HEALTH * CERTIFICATION * February 20, 2016 Allan F Lovely 23 Walton Rd Harwich MA 02645 Congratulations, We are pleased ta inform yau that you have successfuliy completed the requirements for certification by the Massachusetts Department of Public Health (DPH) as an EMT Basic. A wallet card attesting to your certification is attached be(ow. You must carry this wallet card, current BLS CPR (and ACLS if Paramedic) wailet card, and a current driver's license with you when you are acting as an EMT Basic. Please note your expiration date. You must renew this certification by the expiration date listed on the card. This certification requires a specific number of hours to renew as well as submission of an application and fee. Information on the continuing education requirements to renew your certification can be found on our website at http://www.mass.qov/dph/oems. A reminder that if you hold NREMT certification, you are required to maintain it as a condition af your Massachusetts certification. Please notify Massachusetts OEMS of any changes in your name, address, phone number or email. If you have any questions, please contact our office by emailing oems.recert@state.ma.us. Respectfully, �� !�Ai".�iu.�.l t �nn�o Intn�-im Llen��}r �lirr.�Ct`.r g �n�� nf LJnn1+4�. (`n.-n G`n� +.i i-1 (l !'+.. J. S;ru...,,u, .., �„ Nu.} ,,.. .,,, �r�uu �� , ,..u,.,� ,.,:.�,� �«�.y a„�, .�uu��.y 99 Chauncy Street, 11"' Floor, Boston, MA 02111 www.mass.qov/dph/oems Foid Then Oetach A1ong Pul PertwaGons . ��w.,_ �+ www.mass.goV/dphfoetns �,•a�� `=, CUMIIAONWEALTH QF MI�SSACHUSETTa7 ifycuflnCthiscert;ficatiar pleasereturn;tto: �5 uoP�+roerrs-ce;ue�auons Mppy Controf Num6er ,�� _. REP,4RTMENT C3� PUHLIC HEALTH �cna�,rc,.St.,l7thFlcor,8ostqn,btA021'.1 . �.. '. ' '.. . _ _ . �'`w*,�.,rF °: �� ,��, This rard mpst be in your posseuian at al!times white working as an EMT in the Commonweakh of Massachusetts.IYis your reiponsii�iljtyto ' { � maintain your certification in accordance with tRte training and : ,. . recertifIcatian regulations of MDPH/OEMS.This certificaEion is w6je�t to `' the provisrons of the Generdl Laws and EMS System3 regufatlon;as E��g1SIC amemled.This card is not aafid uM�signed by the person to whom�t is issued.Shoutd this card 6e lost contact II+�pPH/OEMS imttttdiatefy. ` Aiian F Louely �''""`�q � � � `+`Y.��,� _ ,, Signature af EMS Provider. � Fold.Then Dt�tach Akxx�AII Perforafions . . G B A S I C L I F E S U P P O R T B A S i C L ! F E S U P P O R T gL�+ ,�t r�°��9 Falmouth Fire MA0068�70# �7 AtttefiCan C2nter Name � Heart �. Pravider �sociation. I�o , Falmouth MA,. . _.. _... ...._ PE�L Course __._ , }�� Allan Lovely • ��ac�o� BCFRTA • . � The above individuak fras successfuliy comptetsd ihe etignitivrg and � skills evaivatiotts in acc�rs�ice with the curriculum of theAmerican Na e°t9iastyne Walorz 12130219��01°# Heart Association Basic ti#e Supp�tt(CPR and A.E�}�'rogr•am. : Holdes's Febru�t�r 15, 2017 Feb 19 signat�re j� I:SuB�2t0� ... . - -RECORIF[i8f[dOC�RCR6W2��8 � . 9 ZOtS Pmar.ca;kieat As^,ora4cn Ta�n:.m`✓!p:s^tt ! '.v7 atte�ds�F��a 75-180i This card contains unique security features to protect against forgery. 15-1805 11/15 ' . : -. :. .... aF. ',' ' . �. v� : - - _ ., s. :yti ._ . . . _. _ .�. _�. _ . . _. _ .s�': � American Training Falmouth Fire MA006�0�# � Heart I �rmericar.Academ} Center Name Association. of Pediatrics �� Tc Falmouth MA_ � �� PEARS� Provider '�f° — - �E�'�� Allan Lovely cO1fSe gCFRTA Location ,�, �__ ------ Tnis card certifies that the above ir.dividual has successfuliy compieted :he cognitive and skills eva:ua:ions in accordance with the curriculum Na e°tit7latthew Malone 03080757b�3y°� o�tFe American Heart Associa:ion Petliatric Emergency � Assessmer,t,Recognitian,and Stabiliiation(PEARSj Program. Holder's February 17, 2017 Feb 19 T si9�ature -.� � �__ Issue Date RecemmendeC Rsnevral Da:e fl 2ct2 a.e:a�HeanAiaocfation remoerir,rrrm cerewr➢a�;erRs eppeerance. 9e-tate This card contains unique security features to protect against forgery. 90-1819 6/12 B L S � American TC TC ID# HeaYt Alignment Safety Program Consultants, Inc MA4688 I n s t r u c t o r Associationd re p0 B�x 259 508-252-3049 —g. Address PEEL ----- — - -------- �{�� Allan Lovel rc Y c�ri,sc�te Rehoboth, MA ziP 02769 —�- -- ----------- - — - - --------- --- -- ---- This cart]certifies that the abcve�ndividu2i is an Americar Haart Instructor Association Basic Life Support BLS)lnstn;c±or �p� 05140248359 01/01/2016 Q1/01l2018 Holder's �� Signafure :ssue Date =xpiratior�ate � +�2e-�r.,err ea^Assodat�on ramwrrrr�r„_ �- �rer xi!�ar._w�ts��pearance. 9c-�to0 This card contains unique security features to protect against forgery. � on-i�cn s;i i � • : � �� `� O '` ) � � � � � s m� <� p � p �� ti � � � � � � � a � � � � � a 0 a � � M � W � v � a g � m � y « � � � o O {, ` C) ,� N � ��p O� � .G� m a O � t�t3-. p E o �Y E n' � 'C a$ � v"m � v 'c � � � U �r � 3a o > � Ei m ss€ '�� II - C� � p� C O `dp � I f� �� f� � � � � � o 0 � . • . _ °� �� . r . _ ° � ❑ ❑ y� � � �' � � � � � ` ` � C �3 � C i�3 �W i� a � � o Q � � o � E � � �, � � �. E � ��' � � L } V ` � � N m � O � �a � N m A d � � � o V � L � � N � £ w v �, � .� � � �� ,m � v C9 O � �- � v �,y `yB :: •� .. a� m = G 0? mm H� �� m � Q � � �� ~ ,�aJ� E n � � �� ,, �� E n, � � � p $ � �'va`► m v � � ` � $� v"m 8 v f � � U U.c Q cg� � � U U V t �� c�Q � > CJ � I�, i i ----.... .__. . ..---._--� . ( + , ' ' 4 . .. . i I ��. - '_` ._ .��__.._...�..�_ '_�_.�_ ' '= � . � �Security Control No. i ; � John Duncan 13 3 614 �� has completed the i NSC First Aid Course � i f Training Center: 311739 � ' Completion Date: 112112017 � � F�cpires: 112��Z ZO � Instructional Hours: � ' _ �D 3/3SS - � � 4 In uctor Sign ure Instructor No. *R � -. . . . . . . . •. .. -. � � � �. _.� . _..� ._ . ___._._ .._ __ _ �+-. � , ,_ x } -- ___ _�__ — _�_ _ �` Security Control No. � John Duncan 2 J 7 255 �..� has compfeted the � NSC CPR Course , �� Training Center: 311739 � ; Comp�etion�ate: 112112017 F�cpires: 11211 01Q Instructional Hours: 4 Q laSs t i tructor Sig ture Instructor No. � `� --. . . . . . . . -. .. -. �` r" `�"�_'f�- � , • . HEQiRTSAVER FIRST AID CPR AED HEARTSAYER FIRST AtD CPR AED Heartsaver� P� Atlleriq� Training �E.M.EJCommonHealth CP��A20277 Genter Nam ' First Aid CPR AED Heart 14ssociationn jC 1��K��,,n R Marstons Mills,MA 02348 --> Info _ °�': _ .. PEE! . HERE HARRI�T MURPHY . i�ocation S.Yarmouth United Methodist Church --�. --- -------- ' The a6ave individuai has success/ull}r completed the objecfrres and skdis evaluations ��structor io accrottlance wi{hh the curcicWum of ifie AF41 Heartsaver Frst Ftid CPR A@Q Piogram. Name A11an Lovely 05140�� Optional completed mod�des are tlwse NQT markai o�t _ �6��0��1,� ��PR ��1� Holder's Signature Iss�e Da}e Recommended Renewal Date 9 2o'.s MierKan Hesrt nssociatlon Tam�iny;,;rh mis caM w�L aMer its appeaia�. ts-tE52 Strike through the modules NOT completed. This card contains unique security features to protect against forgery. 15-t8i2 21�6 __ HEARTSAYER F1RST AID CPR AED HEARTSAVER FIRST AID CPR AED � � Training �•E.M.E./CommonHealth CPR Tc�{6A�20277 He�f"�$c'aV�r AmeriCan Gertfer Name Fi rst Ai d CP R AED � ,"soc ationv T� 126 Sanfuit Newtown Road,��,s,�0�48 —"—'D' Info . �E��. — --- — -- NER� RUBY ACKERT-HERZIG c°"'� S. Yarmouth United Methodist Church ^,� location —�`------ T The a0ove individual has successiully completed tAe objecttves and 5kilts evaluations InStructor ,{p.# in acccrdance with the curriculum o�the NW Heartsaver First Aid CPR AE�Program. Name Allan Lovely �S 1��s JY Optional compteted modules are those NQI'rr�ticed out 06/1{��l�O ��tCPR ��1� Holder's sig�ature fssue Date i aecommended Renewal aats m 2m s a��,Nrar;a�� r�,�,;r,q wan:nzs rard war are.ru a,c�ea,ar,ce. �5-�s�2 _. __. _ .__.._ Strike through the modules hIOT completed. This card contains unique security features to protect against forgery. t5-1812 2/is HEARTSAYER FIRST AiD CPR AED HEARTSAVER FiRST QID CPR AED Heartsaver° � American TCenter NamE��f��O11�I��th C��A20277 First Aid CP� AED � Heart � s Associationb Tc i26 Santuit Newtawn Ro Marstons Milis MA 02348 �%` [nfa �� _. H�A� DON ELLIC�3TT c°"� 5.yarmouth United Methodist Church �� Location fie above ind'rvidual Ims successtuity canpleted the oh;ectives and slcllis evaWations Instructor in accordance with the cumculum of tlie AHA Heflrtsaver FryK q;d CPR AED Program. Name �lan Lovely 05144�� Optinnal wmpleted modWes are ttmse NOT marked out 06I10��° �� p�1 g Holder's Signature Issue Date Recommended Renewa(Date �p��A,�,;�„H��;ayo„ T�r�eprg widr�as�.d��l alter.ts a��Me. 1>-t$72 Strike through the modules NOT completed. Ttiis card contains unique security features to protect against forgery. 15-t812 2/16 . � � SOLITH YARMOL[TH ` LINITED METHODIST CHLIRCH Reverend Ernest R. Belisle, Pastor June 1, 2017 �� ,� JUN 0 5 2011 ' Mr. Philip Renaud HEAlTH DEPT ; r Health Inspector Town of Yarmouth ' 1146 Route 28 S.Yarmouth MA 02664 ' Dear Mr. Renaud, We are diligently working to obtain the necessary certifications for our 2017 Non- Profit Food Service Application. Connie Swedlund will be taking the ServSafe course with Tom Murphy of The Irish Village on June 19, 2017. One other person may enroll as well. I've attached First Aid and CPR certificates for two of our members. Others will be taking classes at the church on Saturday, June 10, 2017. In addition, a couple of us will take the online allergy course shortly. I would appreciate it if you would please let me know whether there are any other , course requirements that need to be met. Thank you. I will send you all of the necessary forms when we have all of the certificates in hand. Sincerely, �, ��a.�..��.� Ruby P. Ackert-Herzig, Secretary syumc.secretary@verizon.net � 324 Old Main Street,South Yarmouth, MA 02664 � Telephone: 508.398.9482 Fax: 508.398.2972 www.syumc.org � Email:s.yarmouthumc@verizon.net 1 ' �,:'^!'r., v �`� ft"9*'t+�uT' , zf.�A�¢ . � S= .L. _ � . ' r:'- . . .......... . . . ' , ` .,,� .. . .. . . . . . .... .. "€- Security Control No. � John Duncan 13 3 614 has completed the NSC First Aid Course ' �-; Training Center: 311739 ;� comptetion Date: 1121/2017 ' � F�cpires: instructionai Hours: ; �: 112112 20 � � '� �03/35S . , In ructor Sign ure Instructor Na. I �" _. . . . . . . . -. .. -. ' � , � ' � � �� . r_�.�.�.� � �.� ��:'- ,:.r . a., � f�r � r �_r'- �t� ��;. �3?��:=�'��r�� r;_u�,:r��'�� : �. Security Control No. � ° 4 �� ` � '�' 297255 � � � John Duncan � �� ' ��, � 1��= has completed the ' � NSC CPR Course � � . � �; � r: � Training Center: 311739 E ;� � � Comp�etion�ate: 112U2017 �-i ' � �� Expires: 11211 01� Instructional Hours: 4 � y � ; s' � � a �ass � �,�� I tructor Sig ture Instructor Na. �„.`' -c-�.�;:� . j; -+ • • � • � • • -• •• � � •; . �3 � `� � < vag � m� � � � o �� aw� � � � a �' mc ��' u+ M � � c: � �� 3 a� ? c�D � � � �` 8 ��, ��p �v �(� � �' � �' � �v -'_��' � � � � � � � � � �� —p c co jp v �" `$W �* �. � ca .. fl- �' a`� �� a`� � � � � a� � a'� cD � � � N A �� (7 � � p � 3 � n � � m $ �� 3 ' � m $ °� � 3 � c � c 0 9� m � � � c� � � a� � � � � K 3 � �. rn� � � � � � oz a � o � ' � � � � � � � � � � �� a � � + �� + b�' o • �a � 8 0 �a � �: �� 0 ��. � � .. .. �3 � � � �$ � �� „� �' a: a � s a y a a; �' � •� �' �"� �m � O ='t �' � � �o, � �� i 4 a; m m� T �'�'t � ' a -., � o � ' A » � � � W N3 $ > o C� � � � a � C � o �p � � � � � v � � � �' � a �� 0 0 � : a� ' � + � � � �� : i \ �