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HomeMy WebLinkAboutCumberland Farms - 12/31/2019Commonwealth of Massachusetts Town of Mansfield Town of Mansfield 6 Park Row Mansfield, MA 02048 Board of Health to Operate a Food Service In accordance with Regulations promulgated under authority of Chapter 94, Section 305A and Chapter 111, Section 5 of the General Laws, a Permit is hereby granted to:. CUMBERLAND FARMS, INC. Whose place of business is: CUMBERLAND FARMS #0187 30 CHAUNCY STREET License Number: FS-15 Permit Expires: December 31, 2019 Food Fee: $175.00 Milk & Cream BOARD OF HEALTH NichaeCHeaCey, Chairman Permit for the Sale of Tobacco Products Violation of REGULATION AFFECTING SMOKING AND THE SALE, VENDING, AND DISTRIBUTION OF TOBACCO may result in fines, suspension or revocation of this permit. Whose place of business is: CUMBERLAND FARMS #0187 30 CHAUNCY STREET License Number FS-15 Permit Expires: December 31, 2019 BOARD OF HEALTH MichaeCHeaCey, Chairman FOR BOARD OF HEALTH USE ONLY Permit #Issued FOOD ESTABLISHMENT PERMIT APPLICATI (Application must be submitted at least 30 days before the planned oj5,p'n09 16272018 Establishment Name: C), Establishment Address: 'IM J2 Establishment Mailing Address(if different): 0 'y Establishment Telephone No.: Applicant Name & Title: Tnc Applicant Address: 0 . L A `0(0, � ",i Applicant Telephone No.: 2-70 1 Lf 00 24 Hour Emergency No.: (?CIO Applicant E-mail: L So 1 a CC.I e ( U. mio ci i c4ind f Ck 1015 C G 1r, Owner Name & Title (if different from applicant): C j rl I id i ICA ln( Owner Address: _; c, Y I ej� dC r� 1�d Owner Telephone No.: (Sc'c ') --!0 1 �! bu Owner E-mail: Establishment Owned By: If a corporation or partnership, give name, title, and home address of officers or H An Association partner. FQ/A Corporation Name Title Address IN An Individual t E C -t rt r t r�. M A Partnership E9 Other legal Entity Person Directly Responsible For Daily Operations (owner, person in charge, supervisor, manager etc.) Name & Title: I t Ad�resN 6 q,3 �,t c4 -qvA e 6d q i ,e phione No: ( 5c'_';J 0, - 2_0 yg 24 Hour Emergency No: Telephone FAX: E-mail: ,tie ccr� 'to- GutV1, Alt E-Mail: District Or Regional Supervisor (if applicable) Hoxo�a mnrlck&cr Name & Title: Address: xv.3 00\ S:" - 9 10 '9- Telephone No: Lj 24 Hour Emergency No: FAX: 00I� -d-&-lo E-mail: Ty— a Food Establishment Information WATER SOURCE: l D w SEWAGE DISPOSAL: DEP Public Water Supply No: (If applicable) No. of Food Employees: DAYS/HOURS: Name of Person In Charge Certified in Food Protection Management-:5Cdsctr" ► s JL If more than 3 individuals are certified, complete list is on file. '�;4 zc' Person Trained in Anti -Choking Procedures (If 25 Seats or more): Location: Qr RdMoblie Mobile Start Date: Mobile End Date: Mobile Comments: Length of Permit: Location Establishment Type [Retail ( 3500 Sq. Ft) (cod Service up to 100 INCLUDING FOOD TRUCKS $175.00 Food Service up to 101 -200 $250.00 Food Service up to 201 + $300.00 iB Seasonal Seasonal Dates: Temporary Start Date: Temporary End Date: Temporary Time: Rain Dale: Q Supermarkets $400 19 N Caterer $35.00 [f Milk & Cream $10.00 Mobile Food Consession NO PHF PREPARED ON SITE $100.00 Manufacture Frozen Desserts/Ice Cream i- $25.00/freezer 0 Pushcart $50.00 # of Pushcarts: ED Residential Kitchen $100.00 'Retail 0 125.00 Q Retail Snack Food $50.00 Food G Operations Definitions:PHF - Potentially hazardous food(b'meRemperatum controls required) P Non-PHFs - non -potentially hazardous food(no fime/temperature controls required) (Check all that apply): RTE -ready-to-eat foods (Ex. sandwiches, salads, muffins which need no further processing) Sale of Commercially Pre -Packaged Non-PHFs f Sale of Commercially Pre -Packaged PHFs Delivery of Packaged PHFs Reheating of Commercially Processed Foods for Service Within 4 Hours Customer Self -Service of Non PHF and Non - Perishable Foods Only Preparation of Non-PHFs Other Food Operations lJ PHFCooked To Order Preparation of PHFs For Hot And Cold Holding For Single Meal Service Sale of Raw Animal Foods Intended to be Prepared by Consumer [±;<• Customer Self-Service-�.k.. Q Ice Manufactured and Packaged to Retail Sale 0 Juice Manufactured and Packaged Retail Sale Offers RTE PHF in Bulk Retail Sale of Salvage,( or Reconditioned Food I, the undersigned, attest to the accuracy of the information provided In this application an, establishment operation will comply with 105 CMR 590.000 and, all other applicable law. I board of health on how to obtain copies of 105 CMR 590.0091and! lt(q fedeMl FRod Rdek Signature of Applicant -'"'"d- -_-'- -- *" Pursuant to MGL Ch.62C, sec. 49A, I certify under the penalties of perjury at � o my Hot PHF Cooked and Cooled or Hot Held for More Than a Single Meal Service PHF and RTE Foods Prepared For Highly Susceptible Population Facility 0 Vacuum Packaging / Cook Chill Q Use of Process Requiring A Variance and/or HACCP Plan (including bare hand contact alternative, time as a public health Q Offers Raw Or Undercooked Food Of Animal Origin Q Prepares Food/Single Meals for Catered Events or Institutional Food Service To be completed by the Board of Health Total Permit Fee: Payment is due with application Ci waived that the food aen instructed by the and paid state taxes required under law. �, 9 Signature of Individual or Corporate Name: Curt ber and Farms ax epartment Social Security Number or Federal ID: G66 j CS& 165 Flanders Rd F 4 y� Westborough. MA 01581 e and belief, have fled all stale tax returns Town of Mansfield Town of Mansfield - Board of Health 6 Park Row Mansfield, MA 02048 Application for Milk and Cream Permit I hereby make application for a MILK AND CREAM PERMIT, which expires on December 31st of each year. NAME OF BUSINESS: E III V) er Q vl (A ADDRESS: >CJ iIhuunc`t' mcw'"341ttd MA bZ"C'fe, TELEPHONE AT LOCATION: I FAX NUMBER: ';5 OWNER OF BUSINESS: C TELEPHONE OF OWNER: FEDERAL ID/SS NUMBER: FEE: $10.00 PERMIT NUMBER: U-3 SIGNATURE: DATE: Town of Mansfield Town of Mansfield - Board of Health 6 Park Row Mansfield, MA 02048 PERMIT NUMBER: Application for the Sale of Tobacco Products I hereby make application for a permit to sell tobacco products in compliance with the Board of Health Regulation Affecting Smoking and the Sale, Vending and Distribution of Tobacco. By signing this application, I declare that I have read the regulation and am responsible for tobacco product sales regarding federal, state and local laws. This permit expires on December 31st of each year. Violation of this Regulation may result in fines, suspension or revocation of this permit. NAME OF BUSINESS: rr' t LOCATION OF SALE OF TOBACCO PRODUCTS: �_ ) " t; J .d.�.. .A-14uiai_.t4tli 5 Vim" L....�, 4t_t f TELEPHONE AT LOCATION: OWNER OF BUSINESS: �..in`,i:i4ici,.dInc 1(A1,, trf tni` ADDRESS OF OWNER s -;';C . i� 4- s., .',zC�r •�EC,<; _NA t')i. <�i _i TELEPHONE OF OWNER:_.r FAX NUMBER: i.J€f f'`3s G If a corporation or partnership, give name, title, and home address of officers or partner. -r ,c.t- _fit 1 A.F' L ......_.. ........... Briefly describe your tobacco and nicotine delivery product sales training. Attach Et employee training documentation l>rtr `fg a iv s do& i _ t Lrra.wq wvc duio (6aq E't,e'r w1110vv_ 'V\a4 0 �wVtple Jam. ?._ uu� OJso a 4ae heCP _ Co�1t� � _c z€ bole(C `t e� c�. * Provide a copy of current Department of Revenue CT-3T Retail Excise Unit License. FEE: $150.00 CT-3T NUMBER: f � d %y 9 �9 y FEDERAL ID/SS NUMBER: j L� _ ) 6; SIGNATURE: DATE: ,y-�H4rt. Commonwealth of Massachusetts Department Revenue a� m �VJ7 of Christopher C. Harding, Commissioner Y Y nrr apP mass.govdar Letter ID: L1700795008 M ^E Notice Dato: September 18, 2018 Account ID: CGL-10031037-486 RETAILER LICENSE FOR SALE OF CIGARETTES IllrobuthollP4ullrltlydhPhllrlrlhuihiHluurllrtl CUMBERLAND FARMS INC CUMBERLAND FARMS 40176 CUMBERLAND 165 FLANDERS RD WESTBOROUGHMA 01581-1032 Attached below is your Retailer License for Sale of Cigarettes (Form CT-3T). Cut along the dotted line and display at your business location. At any time, you can log into your MassTaxConnect account at mass.gov(masstaxconnect to view and re -print a copy of this license. If you have any questions about your license, call us at (617) 887-6367 or toll -free in Massachusetts at (800) 392-6089, Monday through Friday, 8:30 a.m. to 4:30 p.m. DETACH HERE c,,,lCHps6,� MASSACHUSETTS DEPARTMENT OF REVENUE Form CT-3T Retailer License for Sale of Cigarettes m � 2 y�FA-T pF��SSf" This license must be posted and visible at all times. The sale of tobacco products to anyone under 18 years of age is prohibited. CUMBERLAND FARMS INC Account ID: CGL-10031037.486 CUMBERLAND FARMS #0187 Location ID: 10031037-0481 30 CHAUNCY ST License Number: 447399936 MANSFIELD MA 02048-1958 This certifies that the taxpayer named above is licensed under Chapter 64C of the Massachusetts General Laws to sell at retail at the address shown above. This license is non -transferable and may be suspended or revoked for failure to comply with state laws and regulations. Effective Date: October 1, 2018 Expiration Date: September 30, 2020 51 Commonwealth of Massachusetts Letter ID: 1.149I882624 Department or Rcvcnuc Notice Date: September 17, 2016 Is Christopher C. Harding, COmmlaSlnnCr Account ID: CRL 10031037.489 fyrpP� massaov'dor RETAILER LICENSE FOR SALE OF CIGARS AND SMOKING TOBACCO Iudm�IL'urlrls'lir�l�rl�loudlnlrlul��ulrlll�br'Irin CUMBERLAND FARMS INC CUMBERLAND FARMS 00176 CUMBERLAND 165 FLANDERS RD WESTBOROUGH MA 01581-1032 Attached below is your Retailer License for Sale of Cigars and Smoking Tobacco (Form CT-3T). Cut along the dotted line and display at your business location. At any time, you can log into your MassTaxConnect account at mass.gov/masstaxconnect to view and re -print a copy of this license. If you have any questions about your license, call us at (617) 887-6367 or toll -free in Massachusetts at (800) 392-6089, Monday through Friday, 8:30 a.m, to 4:30 p.m. DETACH HERE u`N°Ss� MASSACHUSETTS DEPARTMENT OF REVENUE Form CT-3T Retailer License for Sale of Cigars and Smoking Tobacco m tT� FNr oFo-� This license must be posted and visible at all times. The sale of tobacco products to anyone under 18 years of age is prohibited. CUMBERLAND FARMS INC Account ID: CRL-10031037-489 CUMBERLAND FARMS i10187 Location ID: 10031037-0679 30 CHAUNCY ST License Number: 2130876416 MANSFIELD MA 02048-1958 This certifies that the taxpayer named above is licensed under Chapter 64C of the Massachusetts General Laws to sell at retail at the address shown above. This license is non -transferable and may be suspended or revoked for failure to comply with state laws and regulations. Effective Date: October 1, 2018 Expiration Date: September 30, 2020 Tobacco Product Sales —Cigarettes, Cigars, Chewing Tobacco, Rolling Papers, and E Cigarettes: Cumberland Farms is dedicated to being a responsible tobacco vendor. All Team Members must comply with the laws concerning the sale of tobacco products to minors. The burden is on the customer to prove they are of legal age. If they refuse to provide proper identification, refuse the sale. In most states, civil penalties for selling cigarettes to minors can be levied against an individual Team Member, as well as the Company. The following procedures must be followed at all times. A violation of the procedures that results in the sale of tobacco products to anyone under eighteen (18) years of age will be addressed with progressive counseling up to an including termination. Exceptions exist in towns in Massachusetts and Long Island, New York locations where the legal age ranges between nineteen and twenty-one (19-21) years of age. Please check with your Store Manager to confirm the legal age to sell tobacco products in your store. 1. Tobacco products must not be sold to anyone less than eighteen (18) years of age. Long Island, NY prohibits anyone less than nineteen (19) years of age and select exception towns in MA where the age is between nineteen and twenty-one (19-21) years of age, from purchasing tobacco products. 2. Anyone appearing to be 30 years of age or under must be asked for the proper picture identification for proof of age. In the State of New York, identification must be requested from any customer appearing to be 30 years of age or under, regardless if the same customer provided identification in the past. Acceptable forms of identification are: • U.S. or Canadian Issued Photograph Driver's License • U.S. or Canadian Issued Photograph Non -Driver Identification • U.S. Active Military Photograph Identification • U.S. Passport with Photograph • Enhanced Driver's license Team Members must look for signs of forgery or alterations such as erasures, type-overs, cutouts and overall workmanship of the identification. Check and compare the photo on the identification to the customer; be sure it's the same person. 3. If a person's age is unverifiable due to lack of proper identification, refuse the sale. 4. More than one form of identification should be checked when an ID is questionable. 5. If there is any doubt after checking the identification for proof of age, refuse the sale. 6. Written notes from parents or guardians granting a minor "permission" to purchase tobacco products are prohibited. No one under the age of 18 may purchase tobacco products under any circumstances. 7. Team Members should watch for indications of legal -aged customers attempting to purchase tobacco for minors. If you believe the tobacco product is destined for the under -aged customer, even if the legal - aged customer is the minor's parent, refuse the sale. Indications would include: minors handing money to legal aged customers; minors handing the Team Member money for the purchase made by a legal - aged customer; a legal aged customer purchasing a variety of cigarette brands. TAX CERTIFICATION FORM I certify under the penalties of perjury that I, to my best knowledge and belief, have filed all state tax returns and paid all state taxes required under law. C tk Wtker-�r , J 1'6-( ens acM t�D6-An Signature of Individual or Corporate Name By: C orate Officer (M datory, if Applicable) ASSISTANT TREASURER �_� —, tit t � .. i � ;.,-✓ **Social Security No. (Voluntanj) or Federal Identification Number *This license will not be issued unless this certification clause is signed by the applicant. ** Your social security number will be furnished to the Massachusetts Department of Revenue to determine whether you have met tax filing or tax payment obligations. Licensees who fail to correct their non -filing or delinquency will be subject to license suspension or revocation. This request is made under the authority of Massachusetts General Law Chapter 62C, section 49A. C:\Users\sleite\Desktop\Scotts Doeuments\Food Establishments- Temp\TAX CERTIFICATION FORM.doc The Commonwealth oflblassachusetts li Departn(ent of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 www.titass.gov/(lia Workers' Compensation Insurance Affidavit: General Businesses, TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information �� Please Print Legiba Business/Organization Name: Cumberland Farms, INC Address:165 Flanders Road City/State/Zip: Westborough, MA 01581 Phone #:508-270-1400 Are you an employer? Check fire appropriate box: Business Type (required): I.0 I am a employer with 3,434 employees (full and/ 5. R] Retail 2. or part-time).* 1 6. ®ReslaurantBar/Eating Establishment am a sole proprietor or partnership and have no 7. Q Office and/or Sales (incl. real estate, auto, etc.) employees working for me in any capacity. 8. Non-profit [No workers' comp. insurance required' 3. We arc a corporation and its officers have exercised 9. ® Entertainment their right of exemption per c. 152, 3](4), and we have 10.D Manufacturing no employees. [No workers' compinsurance required]* I I Health Care 4. ® We are a nor -profit organization, staffed by volunteers, _® with no employees. [No workers' comp. insurance req.j 12.® Other 'An> applmnnl that cheat.+ko,e VI muvt also fill crt the ,eetion below shovdng their rwrlers' compensation policy mformalion. ° `If the corporate officers have exempted themselves, but the corporation has other employees, a workers' compensation policy is required and such an organuntion should check box N I I are au employer that is providing workers' compensation insurance for my employees. Below is the policy information. Insurance Company Name:ACE American Insurance Company Insurer's Address,33 Arch Street,Suite 2900 City'State/'Lip: Boston, MA Policy e or Self -ins. Lie. ;I SCFC64787901 Expiration Date:04/01/2019 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 foe 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 cer*) un 11�, pains and penalties ofperjury that the 1- % Phone B: °vo 41 U 14 11 correct. Official use only. Do not write in this area, to be completed by city or torn official. City or Town: .�v Wr Permit7License Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. Cily/Town Clerk 4. Licensing Board 5. Selectmen's Office 6. Other Contact Person: Phone #: www.ntass.sov'mz '�1 ® o CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 03126I2018 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, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or 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 AOn Risk services Northeast, Inc. Providence RI Office CONTACT NPHONE AME: AD.. No. E.I: CB66) 283-7122 ac. Na: 80D-363-0305 EMAIL A60RESS: 100 Westminster street, loth Floor Providence RI 02903-2393 USA INSURER(S) AFFORDING COVERAGE NAIC IS INSURED INSURERA: ACE American Insurance Company 22667 CUMBERLAND FARMS. INC. INSURER B: Indemnity Insurance CO of North America 4357S 165 Flanders Road Westborough MA 01681 USA Wes INSURER C: ACE Property & Casualty Insurance Co. 20699 NSURER D: NSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570070523071 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING 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. Limits shown are as requested LTR TYPE OF INSURANCE INSD WE POLICY NUMBER MMIDDM'YY1 I'MIDDIFYYYY1 LIMITS A X I COMMERCIAL GENERAL LIABILITY CLAIMS-MAOE El OCCUR XSLG $ SIR applies per policy ter G & condl ions EACH OCCURRENCE $1,000,000 E ORE TED PREMISES Ea occurrence $1,000,000 EP MED EXP(Anyone person) Excluded PERSONAL &ADV INJURY $1,000,000 G EN AGGREGATE LIMIT APPLIES PER: % POLICY ❑ PRO- ❑ LOC JECT OTHER: GENERAL AGGREGATE $10,000,000 PRODUCTS - COMPIOPAGG $4,000,000 A AUTOMOBILE LIABILITY X ANYAUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIREDAUTOS NON -OWNED ONLY AUTOS ONLY ISA-HZ5156523 04/01/201804/01/2019 COMBINED SINGLE LIMIT Ea accident $1,000,000 BODILY INJURY ( Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE Peraccldenp C X UMBRELI-ALIAB EXCESS LIAB X OCCUR CLAIMS -MADE XOOG46621220002 04/01 2018 04 01/2019 EACH OCCURRENCE $5,000,000 AGGREGATE $5,000,000 DED X RETENTION 425, 000 B A WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN ANYPROPRIETOR/PARTNER/E%ECUTIVE OFFIcEWMEMBER ExcLUDEDP (Mandatory in NET I(Yes, descnbe under DESCRIPTION OF OPERATIONS below NIA WLRC64787871 SCFC64787901 04/01/2018 04/O1/2018 04/01 2019 04/O1/2019 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $2,000,000 E.L. DISEASE -EA EMPLOYEE $2,000,000 E.L. DISEASE -POLICY LIMIT $2,000,006 DESCRIPTION OF OPERATIONS f LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) The insurance afforded by the policies described herein is subject to all terms, exclusions and conditions of such policies. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of Mansfield AUTHORIZED REPRESENTATIVE Six Park Row Mansfield MA 02048 USA ©1988.2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD O 2 dl A a40-- o U 54 �J #DM rvSafe TIFICATION JASON OLIVEIRA lw s=,&&s t =Mk&g d6 wJm s ati lath !or do SorvSafoe Faud�nag outoodari Emnuldw, which a aom4bd by die An.ncan New" Stardad, Instme fp/Fmd Pmwvn (OV) 364246 5 0 % UMBER EXA FORM NUMBER 7/17 7/17/20 DATE OF DATE OF EXPW bod knr ggly my for �aaniAautlan ngvvanwin tadf�Nhgmal)f WY,bmlldil10001q�,LEetO, e' � w EXAM FORM NO 4930 CERTIFICATE NO 11109774 ServSafe CERTIFICATION B STACY L WIDROW' % C.NPB CurM U^ ServSafe bNOem Nuns STACYL WIOflOW fJm IRIISD Vm FYnO.b m1/Mle C.b BS7Nl0 1ImWgp Na..o MPWIKONN Hot P.nuun Eeem Fwm Memo e9N 4wM%Bmm ib F...NO%6mn 15 6%M FABSEO M14ea T.ur oft w w umwnN4 Ylmlemenl taa49.I.rySOPa M 10 fm(Ir 1.MNWN 1 skreg, � R blp.9e 1 IJ 11 P t, Un WhR"49.rv+e JE 1J C.lv Cmm{ltlr. wnbflPoWuav II B �•wYan/i�n �`�nv ne wyruf Cwur b^ew`.u��lwm'� niWnnu Selv¢Rf. [wrn.neB Cs v, O u SerV$efe cmmlunoN o STACV, WIOROW ui w W CL w O w V w U 0 z z .; h V J w z P4 z W 04 h� 3 N N �j n � LO LO Q v 0 In, o 5' � 0 0 4 z � A a MD 1 enan Foo'dser'vic , e Offer I In -Store Foodservice`e�r'rfr Roller Grill — We will offer five different roller grill Items — All will be received frozen and slacked as needed — All will be heated until 165 degrees and then held for a maximum of four hours at or above 140 degrees. Condiment Rail ted s such as t Peppers and salsa are on are shipped and stored refrigerated in disposable 1/fire pans and arelchanged every 12 hour, Or aafed rail next to the roller grill. They are ahl Heat and Eat Breakfast ores needed. — We heat to above 165 degrees and offer Private Label breakfast sandwiches for Immediate consumption in the morning hours. All are unwrapped, heated, in a merry chef oven, wrapped and labeled In new wrapper and held on a warming unit for no more than two hours. Sandwiches are held In refrigerated drawers until heated Pizza by the Slice — Three varieties shipped and stored frozen and heated to order in a high speed convection oven, Humidified cabinets and Held In a warmer hot are other vehicles for sales depending on local BOH requirements. HACCP program has been developed. Chili and Cheese — Aseptic cheese and chili heated in a perlicstaic cabinet and portioned by the guest. Toasted Sandwiches — Upon request a guest may ask to have there sandwich heated by bringing It up to the counter, The foodservice leader will remove from wrap toast the wrap in a new wrap and return to the guest. Dispensed Beverages Cc mbeII-land — We offer the following dispensed beverages: 16 Head Soda Fountain • 2-4 Head Frozen Carbonated Beverage Machines 8 Brew And Serve Coffee Stations Iced Coffee made and dispensed on premises Iced Tea made and dispensed on premises • Frozen Made To Order F'real Shakes Third Part Items .f Ccent�r'I�t We currently offer the following items in our Cold Display cases: 34 different subs and sandwiches from GreenCore USA, Brocton MA • They are delivered thru our distribution center on our own refrigerated trucks • All sandwiches are made and shipped refrigerated. • All sandwiches are coded with a use by data Private Label Breakfast Sandwiches — Breakfast sandwiches are shipped frozen from our distribution center. Slacked in-store under refrigeration and coded for 5 days in our display cases Third Party Items — We also offer a range of desserts, yogurts and small side items which all are refrigerated delivered on our DC trucks all coded with a manufactures use by date the include but are not limited to: — String cheese, puddings and jello parfaits, boiled peeled eggs, frozen cheesecake and dessert parfaits. r y9 (a O Cumberland F A R M S Date of Incorporation: September 14, 1984 State of Incorporation: Delaware Principal Address: 165 Flanders Road, Westborough, MA 01581 Office Telephone: 508-270-1400 Federal ID No: 04-2843586 PRINCIPAL OFFICERS: Ari N. Haseotes President and CEO 165 Flanders Road Westborough, MA 01581 Howard S. Rosenstein Treasurer 165 Flanders Road Westborough, MA 01581 Brian E. Glennon, 11 Secretary 165 Flanders Road Westborough, MA 01581 John T. Daly Assistant Treasurer 165 Flanders Road Westborough, MA 01581 Cumberland Farms, Inc. 165 Flanders Road, Westborough, MA 01581 508-270-1400 www.cumberlandfarms.com Date of Incorporation: State of Incorporation: Principal Address: Office Telephone: Federal ID No: Ari N. Haseotes 165 Flanders Road Westborough, MA 01581 Howard S. Rosenstein 165 Flanders Road Westborough, MA 01581 Brian E. Glennon, II 165 Flanders Road Westborough, MA 01581 John T. Daly 165 Flanders Road Westborough, MA 01581 0 F A R M S September 14, 1984 Delaware 165 Flanders Road, Westborough, MA 01581 508-270-1400 04-2843586 PRINCIPAL OFFICERS: President and CEO Treasurer Secretary Assistant Treasurer Cumberland Farms, Inc. 165 Flanders Road, Westborough, MA 01581 508-270-1400 www.cumberlandfarms.com