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HomeMy WebLinkAboutRte. 106 Wines & Spirits (RNR Liquors Corp.) - 12/31/202144 (5olo 3 6 �50 iq Town of Mansfield Town of Mansfield - Board of Health 6 Park Row Mansfield, MA 02048 PERMIT NUMBER: t - d NOV I4pplication for the Sale of Tobacco Products I fg, ermit 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: LOCATION OF SALE OF TOBACCO PRODUCTS: i _ y TELEPHONE AT LOCATION: 770 -7 i 6 " OWNER OF BUSINESS: P ri 7pJd,�7/iI' P � '`7 CSC.- �- ADDRESS OF OWNER: TELEPHONE OF OWNER: I z EMAIL ADDRESS: If a corporation or partnership, give name, title, and home address of officers or partner. t'f '` I i i / -"L f7 i Briefly describe your tobacco and nicotine delivery product sales training. Attach employee training documentation I. L ,,,.,, , �. ; -b n Ll I LJ ' - E t G.f,�r r_T ., (xr ,/i-, E� ( r�,.:,. s t-1 r'L..i d„? tit r'7r"i b,t C Ltla srL a g g e`1""'E's !f rr' s<fa wf' - k ;,'d _y *Provide a copy of current Department of Revenue CT-3T Retail Excise Unit License. FEE: $150.00 CT-3T NUMBER: J :) ' d , � Lj Lj T' Y f. * t 7 q C 1, 3 J' "> ` FEDERAL ID/SS NUMBER: y¢ 'j f`5 L SIGNATURE: DATE: 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. r"J?1cT/- Signature of Individual or Corporate Name By: Corporate Officer (Mandatory, if Applicable) "*Social Security No. (Voluntary) 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\sleile\Desktop\Scotes Documents\Food Establishments- Temp\TAX CERTIFICATION FORM.doc Age -Restricted Products Policy & Procedures: Tobacco LOCATION Every Employee at this location has the legal and moral responsibility to control the sale and distribution of age -restricted items to ensure these items do not get sold to minors!! TOBACCO PRODUCT SALES POLICY Objective: That all store Employees follow all laws and procedures of this policy related to the sale of tobacco products including: cigarettes, smokeless tobacco, loose tobacco, pipe tobacco, rolling papers, cigars, e-cigarettes, vape and .lighters. The minimum age to purchase tobacco products is twenty one (21) years of age. It is our responsibility as a retailer and members of the community to prevent the sale of tobacco to anyone under the age of twenty one (21). PROCEDURES: 1. This policy will be reviewed with all new Employees before they can operate a cash register and sell tobacco products. 2. All store Employees to take computer based training and successfully pass with 100% prior to starting on a register. This certification to be updated on an annual basis prior to previous year expiration. 3. A valid form of identification will be required for all tobacco purchases regardless of age or frequency of customer visits. Acceptable forms of id are as follows: Valid Massachusetts License Valid Massachusetts state id Valid US passport Valid Out of State License No expired identification will be accepted. scanned into the register. Driver's License is to be scanned into the register system. All other identification from the acceptable list will require manual entry of the date of birth listed on the documentation. 4. If it is suspected that someone is purchasing tobacco for anyone under the age of twenty-one (21) a valid Id will be required from all members of the party. I have read and understand the Mansfield Board of Health Regulations which prohibits the sale of tobacco and nicotine delivery products to anyone under the age of twenty-one (21) years. I also understand that if I fail to follow store policy and local and state laws about the sale of tobacco or nicotine delivery products to any person under the legal age, I could lose my job or be fined. I agree to the following rules about the sale of tobacco products: I will not sell any tobacco products, including cigarettes, cigars, chewing tobacco, bidis, or any other form of tobacco, or any nicotine delivery product to any person under the age of 21. If any person regardless of age attempts to make a tobacco purchase without an acceptable, I will not make the sale. I will not accept a note from an adult giving permission to a person under the age of 21 to buy tobacco products. In turn, management agrees to support my judgment not to make the sale in any of the cases described above. Failure to.follow this policy may result in disciplinary action up to and including termjn tion /) Employee Signature / Store Operator Signature Date iilii�, IE (This form will be maintained in your personnel file as a part of your permanent employee record) A check mark signifies your understanding and agreement. 1 understand and agree that: ©,/ It is against the law to sell any tobacco product and/or nicotine delivery product (e.g. e-cigarettes) to anyone less than 21 years of age, regardless of how old the person looks. E ' Anyone selling tobacco products and/or nicotine delivery products must conclusively establish the customer's age as over 21 years old, by means of government -issued photographic ID. Q/ Anyone selling tobacco products and/or nicotine delivery products must check and verify official government photo ID for anyone less than 27 years of age. 9' 1 must consent to unannounced, periodic inspections and compliance checks of the permitted retail establishment. 9' Flavored tobacco products and vape products (including mint, menthol and wintergreen) can only be sold in licensed smoking bars, for onsite consumption only. U/ Unflavored E-cigarettes with nicotine content over 35 mg/per ml can only be sold in adult -only retail tobacco stores and licensed smoking bars. 0' Flavored e-cigarettes with any strength of nicotine content can only be sold in licensed smoking bars, for onsite consumption only. D/ Self-service tobacco product and/or nicotine delivery product displays from which the customer may select products are prohibited. UThe sale of single or loose cigarettes or cigarettes in packages of fewer than 20 cigarettes is prohibited. X I may not distribute any free samples of tobacco products or nicotine delivery products (e.g. e-cigarettes) and I may not accept any means, instruments or devices that allow for the redemption of tobacco products for free or cigarettes at a price below the minimum retail price determined by the Massachusetts Department of Revenue. Lr Tobacco vending machines are prohibited. Q, Non-residential Roll -Your -Own machines are prohibited. 0' Blunt wraps are prohibited. 9" Penalties for violation of the regulation include monetary fines and/or suspension of this permit for seven or thirty days. 141 1 may not allow any employee to sell tobacco products or nicotine delivery products (e.g. e-cigarettes) until such employee reads this regulation, state and federal laws regarding the sale of tobacco and signs a statement, a copy of which will be placed on file, that he/she has read the regulation and applicable state laws. Gk' I must prominently display a copy of the "Permit to Sell Tobacco and Nicotine Delivery Devices". L3r I must provide the Board of Health with proof of a current "Cigarette Retailers License" from the Massachusetts Department of Revenue (DOR) and my DOR business permit (Attach a copy of each permit/license). C.Y' I must display Department of Public Health signs stating, "Sale of tobacco to Minors is prohibited". D I must display signs provided by the Board of Health that discloses referral information about cessation. 2' If I sell nicotine delivery devices (e.g. e-cigarettes) I must display signs stating that sale of nicotine delivery devices to anyone below the minimum legal sales age is prohibited and that the used of e-cigarettes at indoor establishments is prohibited by local law. I have received, read and understand the Board of Health regulation "Regulation Affecting Smoking and the Sale, Vending, and Distribution of Tobacco and Nicotine Delivery Products" and agree to abide by it. Signature Print Name, 'A-710251-111 r`'r` Date / / 0 0.1 )C? Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: General Businesses Applicant Information Please Print Legibly Busines s/Orgamzahon Name: t2 ,.4 5, d 4 Address: %. f. City/State/Zip: fuk i t i,� f i t c i f` q 6 Phone #: "�7"; r/_ j'/ t .- 1% Are you an employer? Check the appropriate box: Businep Type (required): L ❑ I am a employer with u-/ employees (full and/ 5. ❑ Retail or part-time).* 2. ❑ I have 6. ❑ Restaurant/Bar/Eating Establishment am a sole proprietor or partnership and no 7, ❑ 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 are a corporation and its officers have exercised 9. ❑ Entertainment their right of exemption per c. 152, § 1(4), and we have 10.❑ Manufacturing no employees. [No workers' comp. insurance required]* 4.❑ We are a non-profit organization, staffed by volunteers, 11.❑Health Care with no employees. [No workers' comp, insurance req.] 12.❑ Other *My applicant that checks box #I 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 #I. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy information. Insurance Company Name: ^¢ Insurer's Address: J e / W irz S'erfUrtr / A i-tic : `t City/State/Zip: d't / Yt / f t 1,1L) Cs L K / d: f iv_, /, h :,/ zl _ 0/. U i Policy # or Self -ins. Lic. #V L"'�-r'r ' � � c� �" �- 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 ofperjury that the information provided above is true and correct , n ('ell — f Ed `6 Phone#: r ,1 � - .�r`i'��� li%'� -�, �. s 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/ma a1 � Commonwealth of Massachusetts Letter ID: L0185425472 Q Department of Revenue Notice Date: October 14, 2020 xi Geoffrey E, Snyder, Commissioner Account ID: CRL-18958749-009 pQ4- mass.gov/dor RETAILER LICENSE FOR SALE OF CIGARS AND SMOKING TOBACCO I�III�iI11���I1�IIIII II1IIIII III Jill III III 111111111rild1111111#1 RNR LIQUORS CORP ROUTE 106 WINE & SPIRIT 377 CHAUNCY ST MANSFIELD MA 02048-1169 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 4ys56` "usF'� MASSACHUSETTS DEPARTMENT OF REVENUE Form CT-3T m w Retailer License for Sale of Cigars and Smoking Tobacco mop4 This license must be posted and visible at all times. The sale of tobacco products to anyone under 18 years of age is prohibited. RNR LIQUORS CORP Account ID: CRL-18958749-009 ROUTE 106 WINE & SPIRIT License Number: 1840187392 377 CHAUNCY ST MANSFIELD MA 02048-1169 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 14, 2020 Expiration Date: September 30, 2022 51 Commonwealth of Massachusetts Letter to: L1700923968 51. • ggjj'�' Department of Revenue Notice Date: May 21, 2020 Geoffrey E. Snyder, Commissioner Account to: EDL-18958749-012 oF� mass.gov/dor LICENSE FOR SALE OF ELECTRONIC NICOTINE DELIVERY SYSTEMS �Illlll�tIIIII'll�l�l�'III'll'�I�nup�ll'1�111111161ut��Plu RNR LIQUORS CORP N ROUTE 106 WINE & SPIRIT 377 CHAUNCY ST MANSFIELD MA 02048-1169 Attached below is your Retailer License for Sale of. Electronic Nicotine Delivery Systems. 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 CNUSerTw MASSACHUSETTS DEPARTMENT OF REVENUE ` y Retailer License for Sale of Electronic Nicotine Delivery Systems ��'F oF� This license must be posted and visible at all times. The sale of G) tobacco products to anyone under 21 years of age is prohibited. RNR LIQUORS CORP Account IDc EDL-18958749-012 ROUTE 106 WINE & SPIRIT License Number: 543369216 377 CHAUNCY ST MANSFIELD MA 02048- l 169 This certifies that the taxpayer named above is licensed under Chapter 64C of the Massachusetts General Laws to sell electronic nicotine delivery systems 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: May 21, 2020 Expiration Date: September 30, 2022 .59tFtl{r7, Commonwealth of Massachusetts Department of Revenue b Geoffrey E. Snyder, Commissioner Fr,.�pp4' mass.gov/dor o• o Letter ID: L1757918784 0 n Notice Date: September 25, 2020 Account ID: CGL-18958749-006 RETAILER LICENSE FOR SALE OF CIGARETTES lhhP�rpIIlllutPhlhl�Prl�llul�d��tldhm���l�lhul RNR LIQUORS CORP o ROUTE 106 WINE & SPIRIT w = 377 CIIAUNC V ST MANSFIELD MA 02048-1169 Attached below is your Retailer License for Sale of Cigarettes (Form CT-3). 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 6 ghcHUSF� MASSACHUSETTS DEPARTMENT OF REVENUE Form CT-3 m Retailer License for Sale of Cigarettes yn, MEvro44� This license must be posted and visible at all times. The sale of tobacco products to anyone under 18 years of age is prohibited. RNR LIQUORS CORP Account ID: CGL-18958749-006 ROUTE 106 WINE & SPIRIT License Number: 772712448 377 CHAUNCY ST MANSFIELD MA 02048-1169 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, 2020 Expiration Date: September 30, 2022 RNRLI-1 OP ID: MK DATE (MMIDDIYYYY) 10126/2020 ACORO' CERTIFICATE OF LIABILITY INSURANCE 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 endorsements . PRODUCER 508.528.3310 Keefe Insurance Agency 51 West Central Street CONTACT Matthew Keras NAME: PHONE 508-528-3310 F^% 508-528-3887 ac, No, E:O: (ac, No): EAAIE Franklin, MA 02038 Matthew Keras ---- INSURER S AFFORDING COVERAGE NAIC It INSURER A: Liberty Mutual Insurance IN APR uors RIJR LI Dannyy atel 377 ChRuncy St Mansfield, MA 02048 INSURERS_______,_ INSURERC: INSURERD: INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 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. INSR IML TYPE OF INSURANCE OOL Ran UBR MIDPOLICY NUMBER POLICY EFF POLICY EXP LIMITS _ A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE [X]OCCURBZS59334896 01/22/2020 01/22/2021 EACH OCCURRENCE $ 1,000,000 RREA8E5 EREoNcaure ce t 11000,000 MED E%P An one erson 15,000 X Liquor Liability PERSONAL S ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY LOC OTHER: GENERAL AGGREGATE 1210001010 PRODUCTS-COMP/OP AGO t 21000,000 AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS p AUTOS ONLY AUTOS W ONLY COMBINED SINGLE LIMIT IEaatrsidettU—_ $ BODILY INJURY Perperson) $ BODILY INJURY Per accident $ PROPERTY aiGCenDAMAGE $ UMBRELLA LIAR EXCESS LIAS OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE DED RETENTION$ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY y/N ���FICERIM IMBEwE%CLUDED? ECUTIVE ❑ (MentlataryIn NH) i(yes, describsun der DESCRIPTION OF OPERATIONS below N / A XWS59334896 01/2212020 01/22/2021 PER U E ETH E.L. EACH ACCIDENT 100,000 E.L. DISEASE - EA EMPLOYEE $ 100,000 E.L. DISEASE- POLICY LIMIT 500,000 It DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule, may be amumed if more space is required) Liquor Store MANSF10 Town of Mansfield 6 Park Row Mansfield, MA 02048 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Matthew Keras ACORD 25 (2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Town of Mansfield Board of Health PERMIT To license the: Sale of Tobacco & Nicotine Delivery Products In accordance with Regulations promulgated under authority of Chapter 94, Section 3o5A and Chapter in, Section 5 of the General Laws, a Permit is hereby granted to: Dashrathbhai M. Patel Whose place of business is: RNR Liquors Corp DBA Route 106 Wine & Spirits located at 377 Chauncy Street In the event of change in the permit holder, the Health Department must be notified of change within io business days. Permit Expires: 12/31/2020 License Number: T-1 /►Nl c; Hea-C , BOARD OF HEALTH Fees Paid: $ 150.00 THIS PERMIT SHOULD BE POSTED CONSPICUOUSLY Age -Restricted Products Policy & Procedures: Tobacco LOCATION Every Employee at this location has the legal and moral responsibility to control the sale and distribution of age -restricted items to ensure these items do not get sold to minors! 1 TOBACCO PRODUCT SALES POLICY Objective: That all store Employees follow all laws and procedures of this policy related to the sale of tobacco products including: cigarettes, smokeless tobacco, loose tobacco, pipe tobacco, rolling papers, cigars, e-cigarettes, vape and lighters. The minimum age to purchase tobacco products is twenty one (21) years of age. It is our responsibility as a retailer and members of the community to prevent the sale of tobacco to anyone under the age of twenty one (21). PROCEDURES: 1. This policy will be reviewed with all new Employees before they can operate a cash register and sell tobacco products. 2. All store Employees to take computer based training and successfully pass with 100% prior to starting on a register. This certification to be updated on an annual basis prior to previous year expiration. 3. A valid form of identification will be required for all tobacco purchases regardless of age or frequency of customer visits. Acceptable forms of id are as follows: Valid Massachusetts License Valid Massachusetts state id Valid US passport Valid Out of State License No expired identification will be accepted. . ..V 4VJ ... VJl 4, YIJVM f.r ...V....V4 lV ♦..V VVJ....... rr..... .... a �...-. scanned into the register. Driver's License is to be scanned into the register system. All other identification from the acceptable list will require manual entry of the date of birth listed on the documentation. 4. If.it is suspected that someone is purchasing tobacco for anyone under the age of twenty-one (21) a valid Id will be required from all members of the party. I have read and understand the Mansfield Board of Health Regulations which prohibits the sale of tobacco and nicotine delivery products to anyone under the age of twenty-one (21) years. I also understand that if I fail to follow store policy and local and state laws about the sale of tobacco or nicotine delivery products to any person under the legal age, I could lose my job or be fined. I agree to the following rules about the sale of tobacco products: I will not sell any tobacco products, including cigarettes, cigars, chewing tobacco, bidis, or any other form of tobacco, or any nicotine delivery product to any person under the age of 21. if any person regardless of age attempts to make a tobacco purchase without an acceptable, I will not make the sale. I will not accept a note from an adult giving permission to a person under the age of 21 to buy tobacco products. In turn, management agrees to support my judgment not to make the sale in any of the cases described above. Failure to.follow this policy may result in disciplinary action up to and including termination. Employee a7te Store Operator Signature Date �A 0 _ Date (This form will be maintained in your personnel file as a part of your permanent employee record) Age -Restricted Products Policy & Procedures: Tobacco LOCATION M Every Employee at this location has the lesal and moral responsibility to control the sale and distribution of age -restricted items to ensure these items do not get sold to minors! I TOBACCO PRODUCT SALES POLICY Objective: That all store Employees follow all laws and procedures of this policy related to the sale of tobacco products including: cigarettes, smokeless tobacco, loose tobacco, pipe tobacco, rolling papers, cigars, e-cigarettes, vape and .lighters. The minimum age to purchase tobacco products is twenty one (21) years of age. It is our responsibility as a retailer and members of the community to prevent the sale of tobacco to anyone under the age of twenty one (21). PROCEDURES: 1. This policy will be reviewed with all new Employees before they can operate a cash register and sell tobacco products. 2. All store Employees to take computer based training and successfully pass with 100% prior to starting on a register. This certification to be updated on an annual basis prior to previous year expiration. 3. A valid form of identification will be required for all tobacco purchases regardless of age or frequency of customer visits. Acceptable forms of id are as follows: Valid Massachusetts License Valid Massachusetts state id Valid US passport Valid Out of State License No expired identification will be accepted. scanned into the register. Driver's license is to be scanned into the register system. All other identification from the acceptable list will require manual entry of the date of birth listed on the documentation. 4. If it is suspected that someone is purchasing tobacco for anyone under the age of twenty-one (21) a valid Id will be required from all members of the party. I have read and understand the Mansfield Board of Health Regulations which prohibits the sale of tobacco and nicotine delivery products to anyone under the age of twenty-one (21) years. I also understand that if I fail to follow store policy and local and state laws about the sale of tobacco or nicotine delivery products to any person under the legal age, I could lose my job or be fined. I agree to the following rules about the sale of tobacco products: I will not sell any tobacco products, including cigarettes, cigars, chewing tobacco, bidis, or any other form of tobacco, or any nicotine delivery product to any person under the age of 21. if any person regardless of age attempts to make a tobacco purchase without an acceptable, I will not make the sale. I will not accept a note from an adult giving permission to a person under the age of 21 to buy tobacco products. In turn, management agrees to support my judgment not to make the sale in any of the cases described above. Failure to,follow this policy may result in disciplinary action up to and including termination. Employeeature Store Operator Signature I1.14-2/0 Date I( Icc0 (This form will be maintained in your personnel file as a part of your permanent employee record) , Age -Restricted Products Policy & Procedures: Tobacco LOCATION Every Employee at this location has the legal and moral responsibility to control the sale and distribution of age -restricted items to ensure these items do not get sold to minors!! TOBACCO PRODUCT SALES POLICY Objective: That all store Employees follow all laws and procedures of this policy related to the sale of tobacco products including: cigarettes, smokeless tobacco, loose tobacco, pipe tobacco, rolling papers, cigars, e-cigarettes, vape and.lighters. The minimum age to purchase tobacco products is twenty one (21) years of age. It is our responsibility as a retailer and members of the community to prevent the sale of tobacco to anyone under the age of twenty one (21). PROCEDURES: 1. This policy will be reviewed with all new Employees before they can operate a cash register and sell tobacco products. 2. All store Employees to take computer based training and successfully pass with 100% prior to starting on a register. This certification to be updated on an annual basis prior to previous year expiration. 3. A valid form of identification will be required for all tobacco purchases regardless of age or frequency of customer visits. Acceptable forms of id are as follows: Valid Massachusetts License Valid Massachusetts state id Valid US passport Valid Out of State License No expired identification will be accepted. scanned into the register. Driver's License is to be scanned into the register system. All other identification from the acceptable list will require manual entry of the date of birth listed on the documentation. 4. If it is suspected that someone is purchasing tobacco for anyone under the age of twenty-one (21) a valid Id will be required from all members of the party. I have read and understand the Mansfield Board of Health Regulations which prohibits the sale of tobacco and nicotine delivery products to anyone under the age of twenty-one (21) years. I also understand that if I fail to follow store policy and local and state laws about the sale of tobacco or nicotine delivery products to any person under the legal age, 1 could lose my job or be fined. 1 agree to the following rules about the sale of tobacco products: I will not sell any tobacco products, including cigarettes, cigars, chewing tobacco, bidis, or any other form of tobacco, or any nicotine delivery product to any person under the age of 21. If any person regardless of age attempts to make a tobacco purchase without an acceptable, I will not make the sale. I will not accept a note from an adult giving permission to a person under the age of 21 to buy tobacco products. In turn, management agrees to support my judgment not to make the sale in any of the cases described above. Failure to,follow this policy may result in disciplinary action up to and including terming ' Employee Si2n Store Operator Signature � \ 6 ad Date iII9I2z Date (This form will be maintained in your personnel file as a part of your permanent employee record) Age -Restricted Products Policy & Procedures: Tobacco LOCATION r. ,2 Lji6� Every Employee at this location has the Ieeal and moral responsibility to control the sale and distribution of age -restricted items to ensure these items do not get sold to minorsl1 TOBACCO PRODUCT SALES POLICY Objective: That all store Employees follow all laws and procedures of this policy related to the sale of tobacco products including: cigarettes, smokeless tobacco, loose tobacco, pipe tobacco, rolling papers, cigars, e-cigarettes, vape and lighters. The minimum age to purchase tobacco products is twenty one (21) years of age. It is our responsibility as a retailer and members of the community to prevent the sale of tobacco to anyone under the age of twenty one (21). PROCEDURES: 1. This policy will be reviewed with all new Employees before they can operate a cash register and sell tobacco products. 2. All store Employees to take computer based training and successfully pass with 1001/6 prior to starting on a register. This certification to be updated on an annual basis prior to previous year expiration. 3. A valid form of identification will be required for all tobacco purchases regardless of age or frequency of customer visits. Acceptable forms of id are as follows: Valid Massachusetts License Valid Massachusetts state id Valid US passport Valid Out of State License No expired identification will be accepted. scanned into the register. Driver's License is to be scanned into the register system. All other identification from the acceptable list will require manual entry of the date of birth listed on the documentation. 4. If it is suspected that someone is purchasing tobacco for anyone under the age of twenty-one (21) a valid Id will be required from all members of the party. I have read and understand the Mansfield Board of Health Regulations which prohibits the sale of tobacco and nicotine delivery products to anyone under the age of twenty-one (21) years. I also understand that if I fail to follow store policy and local and state laws about the sale of tobacco or nicotine delivery products to any person under the legal age, I could lose my job or be fined. 1 agree to the following rules about the sale. of tobacco products: I will not sell any tobacco products, including cigarettes, cigars, chewing tobacco, bidis, or any other form of tobacco, or any nicotine delivery product to any person under the age of 21. if any person regardless of age attempts to make a tobacco purchase without an acceptable, I will not make the sale. I will not accept a note from an adult giving permission to a person under the age of 21 to buy tobacco products. In turn, management agrees to support my judgment not to make the sale in any of the cases described above. Failure to,follow this policy may result in disciplinary action up to and including termination. u,�o A Employee Wature Store Operator Signature 11 19 /-90 Date // A 2 0 Date (This form will be maintained in your personnel file as a part of your permanent employee record)