HomeMy WebLinkAbout2025-26BE!}UIBED MANAGER/CONTACT PERSON
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TOWN OF YARNIOUTH BOARD OF HEALTH
2025/2026 HANDLTNG .{ND STOR{GE OF TOXIC OR HAZARDOUS I\'LATERIALS
LICENSE APPLICATION
COMPLETE THIS APPLICATION AND RETURN IT WITH THE
BY JUNE 30, 2025
PLEASE COMPLE TE ALL OUESTIONS
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USINESS TEL. #k
BTJSINESS ADDRESS IN YARMOUTH
,tNAME O}- BUSINESS
MAILING ADDRESS
EMAIL ADDRESS
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RI.'OUIRFD OWNER NAME
HOME ADDRESS
CORPORATION NAME (II' APPLICABLE)
(.ORPORATION ADDRESS
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IMAILING ADDRESS
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Town of Yarmouth taxes and liens must be paid priol to renewal or issuance ofyour permits. P
appropriately rfpaid: yes'- no- nla /
Under Chapter I 52, Sec. 25C, subsection 6, the Town of Yarmoulh is required to hold issuance or renewal of any
license or pirmit to operate a business ifa person or company does not have a Certification of Workers Compensation
insurance. As part ofthe renewal or issuance ofyour permits, you must complete the enclosed Workers
LICENSES RUN ANNUALLY FROM JULY I TO JTINE 30. IT IS YOUR RESPONSIBILITY TO RETURN
THE COMPLETED APPLICATION(S) AND REQUIRED FEE(S) BY ruNE 30. FAILURE TO DO SO WILL
RESULT IN CLOSURE OF YOUR ESTABLISHMENT UNTIL THE REQUIRED APPLICATIONS(S) AND
FEE(S) ARE RECEIVED. A HEARING BEFORE THE BOARD OF HEALTH MAY BE REQUIRED PRIOR
TO REOPENING
lease check
Compe nsation Aflidavit. If not licable, please explain
REGISTRATION FORM SIGNED AND COMPLETED
CHECK AND WORKERS COMP AFFIDAVIT ENCLOSED
ALL SAFETY DATA SHEETS ONFILE
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ANY NEW CHEMICALS MUST BE PRE-APPROVED BY THE HEALTH DEPARTMENT.
RENEWAL APPLICATION / NEW APPLICATION-
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t- tL--APPLICANT'S SIGNATURE DATE
TAX ID (FEIN OR SSN)BEqUIBSD
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^AIM Mutual
A.l.M. Mutual lnsurance Company
Marsachusetts Employers lnsurance Company
New Hampshire Employers lnsurance Company
Associated Employers lnsurance CompanyInsurance Companies
since1989
o3111t2025
The Hilb Group ot New England LLC
973 lyannough Road
Hyannis, MA 02601
lnsured: Cape Cod & lslands Council lnc Boy Scouts oI
Re: Workers Compensation Insurance Policy
vwc-l00601431G2025
Enclosed is wo*ers compensation policy # VWC-100-6014316-2025A for
Cape Cod & lslands Council lnc Boy Scouts ol America, effective 0313112025.
Please note that this policy is also available online at www.aimmutual.com via our
ServicesOnline Web Portal.
As always we appreciate your business and please do not hesitate to contact your customer
service representative if you have any questions.
Sincerely,
Kevin Snyder
Director of Sales & Marketing
54 Third Avenue o P.O. Box 4070 " Burlington, MA 01803-0970 . Te1787.22!.L600 I 800.876.2765 o Fax: 781.270.5599
WORKERS, COMPENSATION FOR EMPLOYERS THROUGHOUT NEW ENGTAND
sponsored by Associqted lndustries of MossochusetE