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Home My WebLink AboutApp-License-Certifications ��. .•I f4N:..o. TOWN OF YARMOUTH BOARD OF HEALTH APPLICATION FOR LICENSE/PERMIT - 2022 * Please complete form and attach all necessary documents by December 18, 2021. Failure to do so will result in the return of your application packet. ESTABLISHMENT NAME:A 11 Se- (-kcc�l'}�,(F� 1rv�2 TAX ID: � LOCATION ADDRESS: (lq �$' sr,�F-{ �JaR�,.� 4 LA 0,2 66 C...1 TEL.#: c-pq-314-1 6 oo MAILING ADDRESS: Sp.,M-e c me E-MAIL ADDRESS: cu Ise 03.041 . Corm . OWNER NAME: CO v.ti. maz CORPORATION NAME (IF APPLICABLE): A-R cacr-xs H c c "l- 1T(-1 v.Q . MANAGER'S NAME: s s e 101 P y ;ti TEI #: 50q-3.44--(6 c, MAILING ADDRESS: c u- c ce 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. D p'flc 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. fl , cut vYt e f c J J 2. (9-46kte,dtU Lon1 CcA-4- 3. r\ loci 4. FOOD PROTECTION MANAGERS - CERTIFICATIONS: 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. Please attach copies of certification to this application. The Health Department will n i • • • ' • t ds. You must provide new copies and maintain a file at your establishment. 1. .�t(ef, t 1 2. DEC 1 3 i PERSON IN CHARGE: " `' ^r="T. Each food establishment must have at least one Person In Charge (PIC) on site during hours of operation. 1. �c�c �t�.�c- r .e) 2. 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. `�cxoi��. Pc-a-J 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. 1. /G‘ 2. 3. 4. RESTAURANT SEATING: TOTAL# OFFICE USE ONLY 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: LI NSE REQUIRED FEE PERMIT# LICENSE REQUIRED FEE PERMIT# LICENSE REQUIRED FEE PERMIT# 0-100 SEATS $125 ONTINENTAL $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 —FROZEN DESSERT $40 TOBACCO $110 NAME CHANGE: $15 AMOUNT DUE = $ *****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 INSURANCE ATTACHED I/ 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 V 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 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. OUTSIDE CAFÉS: 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. TOBACCO PRODUCT PERMIT CAP A tobacco permit holder who has failed to renew his or her permit within thirty (30)'days of the previous year's permit expiration date is considered an expired license, and the tobacco license cap is reduced. 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 18, 2020. 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 MAY REQ IRE A SITE PLAN. i DATE: () -\3--02 \ SIGNATURE: PRINT NAME &TITLE: A p Rev. 10/15/19 The Commonwealth of Massachusetts Fee iill' Town of Yarmouth $185.00 Food Establishment License Number: BOHF-17-3824-05 Issue Date: 1/1/2022 Mailing Address: Location Address: ALL SEASONS HOSPITALITY INC. 1199 ROUTE 28 ALL SEASONS RESORT SOUTH YARMOUTH, MA 02664 1199 ROUTE 28 SOUTH YARMOUTH, MA 02664 IS HEREBY GRANTED A 2022 LICENSE TO OPERATE: Food Service; Common Victualler This license is granted in conformity with the statutes and ordinances relating thereto, and expires December 31, 2022 unless sooner suspended or revoked and is not transferable. Conditions SEATING: Breakfast Room-44 Green House Room- 30 Board Hillard Boskey,M.D.,Chairman Mary Craig, Vice Chairman of Charles T. Holway,Clerk Debra Bruinooge Health Eric Weston 40 / 1 .0) Bruce G. Murp ,, MPH,R.S.,CHO Health Director The Commonwealth of Massachusetts Fee Town of Yarmouth $110.00 Lodging License Number: BOHL-17-3814-05 Issue Date: 1/1/2022 Mailing Address: Location Address: ALL SEASONS HOSPITALITY INC. 1199 ROUTE 28 ALL SEASONS RESORT SOUTH YARMOUTH, MA 02664 1199 ROUTE 28 SOUTH YARMOUTH, MA 02664 IS HEREBY GRANTED A 2022 LICENSE TO OPERATE: Motel This license is granted in conformity with the statutes and ordinances relating thereto, and expires December 31, 2022 unless sooner suspended or revoked and is not transferable. Conditions ROOMS: 144 Board Hillard Boskey, M.D.,Chairman Mary Craig, Vice Chairman of Charles T.Holway,Clerk Debra Bruinooge Health Eric Weston . I Bruce G. Murphy,MPH, !'.S., HO Health Director The Commonwealth of Massachusetts Fee Town of Yarmouth $110.00 Swimming Pool Operations License Number: BOHSP-17-3817-05 Issue Date: 1/1/2022 Mailing Address: Location Address: ALL SEASONS HOSPITALITY INC. 1199 ROUTE 28 ALL SEASONS RESORT SOUTH YARMOUTH. MA 02664 1199 ROUTE 28 SOUTH YARMOUTH, MA 02664 IS HEREBY GRANTED A 2022 LICENSE This license is granted in conformity with the statutes and ordinances relating thereto, and expires December 31, 2022 unless sooner suspended or revoked and is not transferable. Conditions INDOOR SWIMMING POOL Board Hillard Boskey,M.D.,Chairman Mary Craig, Vice Chairman of Charles T. Holway, Clerk Debra Bruinooge Health Eric Weston • ZAK Bruce G. Murphy,MP ,R.S.,CHO Health Director The Commonwealth of Massachusetts Fee Town of Yarmouth $110.00 Swimming Pool Operations License Number: BOHSP-17-3822-05 Issue Date: 1/1/2022 Mailing Address: Location Address: ALL SEASONS HOSPITALITY INC. 1199 ROUTE 28 ALL SEASONS RESORT SOUTH YARMOUTH. MA 02664 1199 ROUTE 28 SOUTH YARMOUTH, MA 02664 IS HEREBY GRANTED A 2022 LICENSE This license is granted in conformity with the statutes and ordinances relating thereto, and expires December 31, 2022 unless sooner suspended or revoked and is not transferable. Conditions WHIRLPOOL/VAPOR BATH Board Hillard Boskey,M.D.,Chairman Mary Craig, Vice Chairman of Charles T.Holway, Clerk Debra Bruinooge Health Eric Weston P.°(--J1 Bruce G. Murphy,MP , R. ., CHO Health Director vfJca.c vJ lis rwacsuuviw r. I 1 Congress Street, Suite 100 =„• Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: General Businesses Applicant Information Please Print Legibly Business/Organization Name: L ,, ; »c 4 0( (4 Address: j c k '1 City/State/Zip:< * i . ygiw.c f 1.\. PVA o 6 Phone #: 3c( 6 cc' Are you an employer? Check the appropriate box: Business Type(required): 1.0 l am a employer with - employees (full and/ 5. [=1 Retail or part-time).* 6. ❑ Restaurant/Bar/Eating Establishment 2.❑ I am a sole proprietor or partnership and have no 7• ❑ Office and/or Sales(incl. real estate,auto, etc.) employees working for me in any capacity. [No workers' comp. insurance required] 8• El Non-profit 3.❑ We are a corporation and its officers have exercised 9. ❑ Entertainment their right of exemption per c. 152, §1(4), and we have 10.❑ Manufacturing DEC 1 3 2021 no employees. [No workers' comp. insurance required]* 4.ElWe are a non-profit organization, staffed by volunteers., 11•❑ Health Care HEALTH DEPT. with no employees. [No workers' comp. insurance req.] 12.E:1/Other1 t ' , ,` 1- ci 747 *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. **If the corporate officers have exempted themselves,but the corporation has other employees,a workers'compensation policy is required and such an organization should check box#1. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy information. Insurance Company Name: HO✓c .e (.71ic1,2 ez— -y`gLi 2ao. Cc_m-{l��rsir Insurer's Address: ' Lt 61 4 N (L4 2 u City/State/Zip: Policy#or Self-ins. Lic. # ( f../c S" _ ( - i.:} - L 1 Expiration Date: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of investigations of the DIA for insurance coverage verification. I do hereby certify,,under the pains and penalties of perjury that the information provided above is true and correct. Signature: /44/ Date: I Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Licensing Board 5. Selectmen's Office 6.Other Contact Person: Phone#: www.mass.gov/dia NOTICE r -"m"---11111====== NOTICE TO _=�I TO EMPLOYEES == = W' EMPLOYEES 9�' `0 v 144 = SN6 The Commonwealth of Massachusetts DEPARTMENT OF INDUSTRIAL ACCIDENTS LAFAYETTE CITY CENTER,2 AVENUE DE LAFAYETTE, BOSTON, MA02111 (617) 727-4900 — www.mass.gov/dia As required by Massachusetts General Law, Chapter 152, Sections 21, 22 &30, this will give you notice that ! (we) have provided for payment to our injured employees under the above mentioned chapter by insuring with: HARTFORD UNDERWRITERS INSURANCE COMPANY NAME OF INSURANCE COMPANY P.O. BOX 4614 BUFFALO, NY 14240-4614 ADDRESS OF INSURANCE COMPANY (6S6OUB-1K20561-A-21) 03-22-21 TO 03-22-22 POLICY NUMBER EFFECTIVE DATES J J GILMARTIN & SON AGCY 1293 POST RD o= WARWICK RI 02888 NAME OF INSURANCE AGENT ADDRESS PHONE # ALL SEASONS HOSPITALITY INC 1199 ROUTE 28 SOUTH YARMOUTH <rsLv!sOVisL 1 o� MA 02664 EMPLOYER ADDRESS DEC 1 3 2021 EMPLOYER'S WORKERS COMPENSATION OFFICER (IF ANY) DALE MEDICAL TREATMENT The above named insurer is required in cases of personal injuries arising out of and in the course of employment to furnish adequate and reasonable hospital and medical services in accordance with the provisions of the Workers' Compensation Act. A copy of the First Report of Injury must be given to the injured employee. The employee may select his or her own physician. The reasonable cost of the services provided by the treating physician will be paid by the insurer, if the treatment is necessary and reasonably connected to the work related injury. In cases requiring hospital attention, employees are hereby notified that the insurer has arranged for such attention at the NAME OF HOSPITAL ADDRESS 015110 W20P1G15 TO BE POSTED BY EMPLOYER RECEIVED 12/13/2021 23:18 3:1 8 5083987160 ALL SEASONS RESORT ( 7:• A 1 ;7''N1` seCFK —.y. ---\ jaXi �,t 1" eu ps,- v - n Ak �y r c ky' � ii ' '" .. ,, K, y1 � .Capeud Sa:e .lrain:c�..ccry arc r .t-4 , + NSC First Aid Course n.. 1 Vt fir 0, e 000010, • ' OSHA r10.151 Name: Orlando Wolcott Security Control No. Address: Mariner Resort j 19 4 6 7 7 Address: 573 Main St,Rt 28 CityState,Zip; West Yarmouth,MA 02673 Course Completion Date: 12/02)2020 Training Center: Cape Cod Safety Training Expiration Date: 12102)2022 Instructor Noma: Rick Todd Instructor Number: 1+4t?818 • Orlando Wolcott has successfully completed the NSC First Aid Coi rss. i I IThe National Safety Council eliminates preventable deaths at work,in homes and communities,and on the road through ' 1 leadership,research,education and advocacy.For more life-saving courses from NSC please visit nsc,org/fatraining• l i i• '--�--rr-.---...__.....-.-.--..-�.-_._-.....-,..-.•-..-.-.,-�-.__...__...._..:...-:.._.,:......._.._._..._...,-._.-...-.:.....-..,-..:...•....,,.•....,.-,r•i,-�--..�-��-�..—....................-....,-...•sem I i — iI THIS DOCUMENT IS VOID IF REPRODUCED; ire=vim., L-J uJ2 I 3 2021 HEALTH DEPT. ,fib4yw'41n' r. ..%,,.. 3i�"'` sra.. SCCUYIty'�.'onSY'01 N0. SMP•,, �^ .. ,;:h iYay� .r r, r• r+ 1.4' 0, , Orla0do Wolcott r). 'I :. rias completes the NSC I9Irst Aid Course We want your feedback] 1 Please visit nsc.orgifirstaidevaluation to Training Center Completion Dater Cay¢Cod Safely Training take a brief survey and'share your opinions D plres 121c212024 instructional Hours about the NSC courseyou completed. 4t2(O7J2022 .. I yy 044918 Instructor Signature I Instructor No. NSC-in if for life. nac.org/fatraining .•, _ t7 x1V14/3 a ,I or'u eef .' , 5.,,-,, " t ^F a s 'x' y �" 1 ,,A.+ y> r l hr T.. a.r,: :xxaHipt 51,1 ?Z .'cu .aka:S"s,i�aiaL42U',_46:l'�:*, i 30M04o3p-1 a ,0156 900006129 05015 National Safety Council 7 91 73-0000 RECEIVED 12/13/2021 23:18 5083987160 ALL SEASONS RESORT r'w vl t,,, ;T x ,i, P is r 'ri sK" ,:-...7.:!.14,. :-.. ,s ,,1?r:1,4:....: b! -'',0&,:.',,!:,,4r.- _. i At.7'.�2},�i) �ixg ' � ,1 b•t, it `:o, :4 ;yP. a,, Wf, ., v' .. ua;i o;:.% :. k"`rn"3v�Y�` -,1,,,:-rte` ':r„ , y,y` ,e17 Mir t z "fi" 1 rY.',I 1 �71u"" • \'r'" r'S r: l r p e x Mr t t�'•F- it( r . 'J'�1i;IJ,,,,.. �*,,.: tT a ti 's 4,1. ., �i `Vi rQ;.t✓�E,l b..''e�.'%..G,-y.�3 a,hi a,� 0.Ad .At x.t 16.,,,,,,..,,t;: .` �,y err 4 p< µ w �� Arr ,A'b,v,O.. S-may Course * �"tixr�ifl�� >,'i :c ,�°`Y °� ~ Adult, Child, Inf� t, Choking AED 4.1,4,1-' ''}a p',,'Yi 4q 4; a OSHA CPR 1103.151 1 Name: Orlando Wolcott Security Control No. Address: Mariner Resort c 7 61 r 4 Address: 673 Main St,Rt 28 City,State,Zip: West Yarmouth,MA 02673 Course Completion Date: 1210212020 Training Cenier: Cape Cod Safety Training Expiration Date: 1210212022 Instructor Nardie: Rick Todd Instructor Number: 7040918 I Orlando Wolcott 1 has successfully completed the NSC CPR Course based on the current Guidelines for CPR and ECC. The National Safety Council eliminates preventable deaths at work, In homes and communities,and on the road through leadership,research,education and advocacy. For more life-saving courses from NSC please visit nsc,org/fatraining • ._..._.._.. v.... �..,._..__._-_�._.. _— _ — -- J THIS DOCUMENT IS VOID 1F REPRODUCED 'rn.,-,,t.;:4, 3X. "' ^ a security COftr01 N o. � a 4 ,, i . Orlanc4o Wolcott 8 7 o 5, ::::v0";':-.i.-_:.:0,, .., • 'W,',.'•"r 1 '-ouw" hi!b aw++P�etea tna ,, NSCI CPR Course We want your feedback! Adult,Child,Infant CPR,Choking &AED Training Center: Cod Safety Training Please visit nsc.org/firstaldevaivation to Completion Date: 121112!2020 take a brief survey and share your opinions Explrea: t2I012022 • Instructlonai ho(+s: about the NSC course you completed. 1(2---1,; .4.4 1 #1040918 Instructor Signature l 'Instructor NO: NSC—in it for life° nsc-org/fatraining_) ASV "fL ep!#ti's card for your records Void.if reproduced 50M04012020 1015 900008120 e2016 Narbnel 8erety Council 79174-0000 . a SPI 13, 4� NSC First Aid Course c0ONC% '041 Name: Dharmesh Patel ��JL J Security Control No. Address: All Seasons Resort Address: 1199 Main Street,Rt 28 DCL 1 3 2021 City, State, Zip: South Yarmouth,MA 02664 HEALTH DEPT. Course Completion Date: 12102/2020 Training Center: Cape Cod Safety Training Expiration Date: 1210212022 Instructor Name: Rick Todd Instructor Number: 1040918 Dharmesh Patel has successfully completed the NSC First Aid Course. The National Safety Council eliminates preventable deaths at work, in homes and communities, and on the road through leadership, research, education and advocacy. For more life-saving courses from NSC please visit nsc.orglfatraining I THIS DOCUMENT IS VOID IF REPRODUCED aye ,4 Security Control No. o „s� =COs Dharmesh Patel ' ° 5 , has completed the NSC First Aid Course We want your feedback! Please visit nsc.org/firstaidevaluation to training center: Cape Cod Safety Training take a brief survey and share your opinions I completion Date: 12!0212020 about the NSC course you completed. Expires: 1210212022 Instructional Hours: NSC--%t1 if fw 1_r_ t structnr Cv n�f,,. #1918 ,,y).\1\y.0 apecodsafetytrai ning.com ss NSC CPR Course � A tia air lug 2 c°„N.`v Adult, Child, Infant, Choking & AED OSHA CPR 1910.151 Name: Dharmesh Patel Security Control No. Address: All Seasons Resort 876160 Address: 1199 Main Street,Rt 28 City, State, Zip: S.Yarmouth,MA 02664 Course Completion Date: 12/02/2020 Training Center: Cape Cod Safety Training Expiration Date: 12/02/2022 Instructor Name: Rick Todd Instructor Number: 1040918 Dharmesh Patel has successfully completed the NSC CPR Course based on the current Guidelines for CPR and ECC. The National Safety Council eliminates preventable deaths at work, in homes and communities, and on the road through leadership, research, education and advocacy. For more life-saving courses from NSC please visit nsc.org/fatraining 1P 1 THIS DOCUMENT IS VOID IF REPRODUCED Cs ,=,uVit UC 13 2021 HEALTH DEPT, Security Control No. oma,a4 1 4 Dharmesh Patel 8 7 51 6 0 has completed the your feedback! SC Cour We want ou NSC CPR _ ,,rte 0 : j e Pt or- ori 1 �� v�I ►1 �nrn/fire.+..:.1_•--'---•. _ J.1.. I . 111 111 Al._L:.._ a .�.. km ; NSC First Aid Course a 2 e %NGr OSHA 1 : Name: Jagruti Patel Security Control No. Address: All Seasons Resort 194621 Address: 1199 Main Street,Rt 28 City, State, Zip: South Yarmouth,MA 02664 Course Completion Date: 12102/2020 Training Center: Cape Cod Safety Training Expiration Date: 1210212022 Instructor Name: Rick Todd Instructor Number: 1040918 Jagruti Patel has successfully completed the NSC First Aid Course. The National Safety Council eliminates preventable deaths at work, in homes and communities,and on the road through leadership, research, education and advocacy. For more life-saving courses from NSC please visit nsc.org/fatraining J THIS DOCUMENT IS VOID IF REPRODUCED Mµ8 Security Control No. Jagruti Patel 194621 has completed the NSC First Aid Course We want your feedback! Please visit nsc.org/firstaidevaluation to Training Center: Cape Cod Safety Training take a brief survey and share your opinions Completion Date: 12102,2020 about the NSC course you completed. Expires: 122022 Instructional Hours: L . # NSC-in it forinstructor Signature f0409fA life nsc.org/fatraining Instructor No fi . #� 4`'36l� `t*'Y n . ts .{ 3y T ``�'a= "si*bY @' . /apecodsa2eC�yL1airnng cof,', ,+w ,'e, i {t C rc 4 .,v,; 9 ,,s� tt€fit i -4' % i5'41''' h''' gip` 9 NSC CPR Course ,_,,,, ,,:c. < c0uNu�o Adult, Child, Infant, Choking & AED OSHA CPR 1010.151 Name: Jagruti Patel Security Control No. Address: All Seasons Resort 876161 Address: 1199 Main Street,Rt 28 City, State, Zip: S.Yarmouth,MA 02664 Course Completion Date: 1210212020 Training Center: Cape Cod Safety Training Expiration Date: 12/0212022 Instructor Name: Rick Todd Instructor Number: 1040918 Jagruti Patel has successfully completed the NSC CPR Course based on the current Guidelines for CPR and ECC. The National Safety Council eliminates preventable deaths at work, in homes and communities, and on the road through leadership, research, education and advocacy. For more life-saving courses from NSC please visit nsc.org/fatraining J THIS DOCUMENT IS VOID IF REPRODUCED ��;:- Jc.t. 3 �2021 HEALTH DEPT. Security Control No. P v =Q< Jagruti Patel 876161 ,QOr 2 < has completed the NSC CPR Course We want your feedback! 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