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HomeMy WebLinkAboutHoney Dew Donuts, Inc. (SPCAP, Inc.) - 12/31/2021FOR BOARD OF HEALTH USE ONLY Permit # Issued/ a�. FOOD ESTABLISHMENT PERMIT APPLICATION (Application must be submitted at least 30 days before the planned opening date)`\ Establishment Name Fx ly "F "e, f Establishment Address�- Establishment Mailing Address (if different) Establishment Telephone No Applicant Name & Title: 6 vlii`L e r" 9 Applicant Address -'i t {v i _ K (xw . 4j7-' Applicant Telephone No.: ' ( ( 24 Hour Emergency No.: gi t f Gr ApplicantEmail 2111r1'e4-v kj-o';._ Owner Name & Title (If different from applicant) Owner Address Owner telephone number Owner email: Establishment Owned By: If a corporation or partnership, give name, title, and home address of officers or I'] An Association partner. L-A Corporation Name � r4 Titled Address H An Individual (�_14L 4�( f r o,g f f 3 a E( 1= 5< z H A Partnership H Other legal Entity Person Directly Responsible For Daily Operations (owner, person in charge, supervisor, manager etc.) Name & Title: sf,�'l die -a Address:v"17� (-( Telephone No: �'6/ K- I --C G i7 24 Hour Emergency No: FAX: E-mail: j�# f C _.. -,) Alt E-Mail: > 1.0,J `l G f=/0z , c c^ i. District Or Regional Supervisor (if applicable) Name &Title: cif 61CrE'- 6 G' Address: Telephone No:# f f 7 FAX: I E-mail: JT9 24 Hour Emergency No: Food Establishment Information WATER SOURCE: in SEWAGE DISPOSAL f o co DEP Public Water Supply If applicable "7 ppv No: ( ) I No. of Food Employees: DAYS/HOURS:` Name of Person(s) In Charge Certified in Food Protection Management: Name of Person(s) In Charge Certified in Allergen Awareness Training h Name of pest control company routinely inspecting the premises for evidence of pestsA s y If there is seating for 25 people or more, a person trained in manual choke saving procedures will be onsite at all times food is being prepared. 19 Yes Does this establishment require a FOG permit? If yes, please attach the FOG permit application. Length of Permit: Establishment Type: Annual Retail Food $125.00 Mobile Food Consession a Temporary [!'Food Service up to 100 INCLUDING NO PHF PREPARED ON SITE $100.00 FOOD TRUCKS $175.00 Manufacture Frozen Desserts/Ice Cream Temporary Start Date: Eg Food Service up to 101 -200 $250.00 $25.00/freezer Temporary End Date: .�❑.'� Food Service up to 201 + $300.00 [] Pushcart $50.00 # of Pushcarts: Temporary Time: [ Supermarkets $400 '❑{ Residential Kitchen $100.00 Rain Date: P/Milk &Cream $1 D.00 Caterer $35.00 Food Operations: Definitions: PHF- Potentially hazardous food (timellemperature controls required) (Check all that apply): Non-PHFs -non-potentially hazardous food(no time/temperahme controls required) RTE-ready-to-eat foods (Ex. sandwiches, salads, muffins which need no further processing) ❑-9 Sale of Commercially Pre -Packaged Non-PHFs [Ed PHFCooked To Order 0 Hot PHF Cooked and Cooled or Hot Held ii Sale of Commercially Pre -Packaged PHFs Preparation of PHFs For Hot And for More Than a Single Meal Service ❑7 Delivery of Packaged PHFs Cold Holding For Single Meal Service PHF and RTE Foods Prepared For Highly �z! Sale of Raw Animal Foods Intended Susceptible Population Facility Reheating of Commercially to be Prepared by Consumer 0 Use of Process Requiring A Variance Processed Foods for Service Within 4 Hours and/or HACCP Plan (including bare hand Customer Self -Service of Non PHF and Non- Customer Self -Service contact alternative, time as a public health Perishable Foods Only Ice Manufactured and Packaged for control) of Non-PHFs Preparation Retail Sale p 0 Offers Raw Or Undercooked Food Of E1 Juice Manufactured and Packaged for Animal Origin Other Food Operations Retail Sale Vacuum Packaging /Cook Chill Offers RTE PHF in Bulk Quantities [;] Prepares Food/Single Meals for Retail Sale of Salvage, Out -Of -Date Catered Events or Institutional Food Service or Reconditioned Food I, the undersigned, attest to the accuracy of the information provided in this application and affirm that the food establishment operation will comply with 105 CMR 590.000 and all other applicable law. I have been instructed by the board of health on how to obtain Tples of 1 WAaMEV90.000 and the federal Food Code. Signature of Applicant: ✓'�t�7., Pursuant to MGL Ch.62C, sec. 49A, I certify under the penalties of perjury that I, to my best knowledge and belief, have filed all state tax returns and paid state taxes required under law. Social Security Number or Federal ID: Signature of Individual or Corporate Name. 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. Signature of Individual or Corporate Name By: Corporate Officer ( a datory, if Applicable) c�`F331�m7 �_ "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:\Usere\sleite\Desktop\ScotPs Documents\Food Establishments- Temp\TAX CERTIFICATION FORM.doc The Commonwealth ofMassaehusetts Department oftndustrial Accidents Office of Investigations 600 Washington Street . UlfBoston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: General Businesses Applicant Information Please Print Legibly Business/Organization Name:,C=y- {.. _J t % Address: = { City/State/Zip: { d 10% c�J1Z- (' ( G � (,Phone Are ou an employer? Check the appropriate box: Business Type (required): 1.r I am a employer with employees (full and/ 5. ❑ 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. ❑ 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 t o.❑ Manufacturing no employees. [No workers' comp. insurance required]**11.❑Health Care 4.❑ We are a non-profit organization, staffed by volunteers, with no employees. [No workers' comp. insurance req.] 12.❑aOther _.Dn6 u]t- Jb D -nny appucant mat enecxs oox ni must also Itll 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 ant an employer that is providing wor�ers',roatpensation insuraruce for my employees. Below is the policy information. Insurance Company Insurer's Address:{ —X Lim - >- City/State/Zip: Policy # or Self -ins. Lic. # 0.. F C+ t' f j _ f Expiration Date: AZ�2_{ 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 $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby 5tify, un je ie pa and penalBes ofperjury that the information provided above is true and correct. - Z_as Phone #: 05 - w Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Licensing Board 5. Selectmen's Office 6. Other Contact Person: Phone #: www.mass.gov/dta EXPIRATION DATE: BUSINESS CERTIFICATE TOWN OF MANSFIELD Number: MASSACHUSETTS IN CONFORrvIITY WITH THE PROVISIONS OF CHAPTER 110, SF,CTION 5 OF THE MASSACHUSETTS GENERAL,', LA WS, AS AMENDED, THE UNDERSIGNED DECLARE(S) THAT A BUSINESS IS CONDUCTED UNDER THE TITLE OF: 170 J 4- `v scams/ a 6� (TELEPHONE NUMBER) BY—THF FOLLOWING NAMED PERSON(S)(INCLUDE TITLE, IF CORpORATE..9FFICERJ I'IJLL NAME' RESIDENCE Xp If ON THE ABO,NE NAMED PERSON(S) PERSONALLY APPEARED ;FOR ME A AN OATH THAT THE FOREGOING STATEMENT IS TRUE. MADE "� -- TOWN Cl K/NOTARY PUBLIC ,,��&&,,RUHAINA OMAR My Commission Expires: y�( NoaryPubGc i Vdd�' �,�a �eHholMaeaechuaBgs COMMISSION EXPIRATION DATE �'� Fainrery 23, 2028 DATE. RkEIV�D IN THE TOWN CLERK'S OFFICE 1 BY I.D. PRESENTgD:_ RENEWAL IN A('L'ORDANCB Ili PROVISIONS Ul CHAPIlR 3:P OF"fl'IE ACES OF 1985 AND CHAPTER 1 I0, SECTION 5 OP'rHE M/\SSACHl1Sl'l`CS tiENI:IL\I. LAW$ AS AMENUfi D, 13U$INI_SS CERTIPICA'fES SHALL BE IN L'PPGCT FOR' POUR YEARS 'ROM TIIL DA"fE OP ISSl1B A D SHALL. f3P R(_NBWI D EVI _POUR YEAR5 'fl-IEI-- ZFAf'fFli A S"I'A1"EMENI UNDER OATH Ml1Sl' DE FILED WI-r41'I'HE CI"h'!f WN CLC:RIC UPON DISC'ONTMl11NQ RETIRING OR WI"I'HDRA WING FROM SUCH ER OATH SS OR PA BE FIL SHIP. PILS 13f FUR ISHEDH 'R'QDFS TI SHFlLL BE AVr11LABLL' AT 1}IL AfJURESS A'f WI-IICII SUCH BUSINESS IS CONDUCTED AND SHALL BE M SUCH sl REQUEST DURING RLGIJI.AR BUSINIiSS I-IOURS TO ANY PERSON WHO HAS PURChIASED GOODS OR SERVICES FROM SUCH 13USI ESS. VIOI..AIIONS ARE SUBJECT 10 A PINE OR NOT MORI THAN I I1REE HUNDRED DOLLARS ($300.00) FOR EACH MONTH DURING WHICH SU 'H VIOLATION CONTINUES Town of Mansfield Health Department APPLICATION FOR FATS OILS and GREASE DISCHARGE PERMIT RESTAURANT& FOOD PREPARATION ESTABLISHMENTS Business/ Food Establishment Mailing Phone/Fax Number: �461 ' YZ /— b 3 " T Contact Person/Title for Grease Traps: C�?T j i vt 2 CXV . 6'_)_Yd'c Name of Company scheduled to pump internal grease trap(s) monthly: d : v') 8 teC` Name of Company scheduled to pump external grease trap quarterly: Please attach the following documents to this application: • Most recent waste hauler receipt or waste hauler manifest • Appropriate permit fee based on new fee schedule (Checks can be made out to the Town of Mansfield) Food Establishments Fee 3 grease interceptors/traps or less and/or 1 yellow grease collection $50 container Each grease interceptor/trap over 3 $50 ($200 max) I THE UNDERSIGNED HAVE OBTAINED AND REVIEWED THE MANSFIELD BOARD OF HEALTH FATS, OILS, AND GREASE (FOG) REGULATIONS APPROVED AND ADOPTED ON OCTOBER 4, 2018. In consideration of the granting of the permit, the undersigned agrees to the conditions of the permit and acknowledges that the ' ormation submitted in these documents is true, accurate and complete. r` Signed` °�-` r1' y._ — Date %L7-._ 2 _c> Print Name 'l�� € i%c 2-Z-% Facility Onerational Information Please answer all questions in this section. If an item is not applicable, indicate "N/A". Unless otherwise specified, please print or type. Seating Capacity (per Fire Department Regulation): Seating Capacity (Actual Count): Normal Hours of Food Preparation/Service: Monday Thursday j Sunday _ Tuesday J_- �T c Friday I Wednesday -S Saturday Please indicate the NUMBER of kitchen fixtures used in your establishment and if it is attached to a Grease Removal Units (GRU/trap) Number in establishment Attached to GRU -' 3 compartment sink Handwashing sink Commercial Dishwasher Bar sink / Mop Sink Garbage Disposal Ice Making Machines Fryolators - Grills or Ovens Exhaust Hoods Floor drains Other: How are hood vents cleaned? (i.e., in three (3) bay sink, off site by private company): Is dinnerware pre -rinsed before being washed? If yes, at what station/sink? r Yes c-- No i7 Grease Trans and Grease Removal Internal Grease Traps How many indoor Grease Removal Units (GRU/trap) are on site? Please list fixtures attached to each grease trap Grease Trap 1 to yr Ev fz Grease Trap 2 Grease Trap 3 Grease Trap 4 Grease Trap 5 External Grease Traps Does this establishment have an outdoor Grease Removal Unit (GRU/Interceptor)? Yes ✓ No Size fj -- 3U gallons Where is the existing outdoor GRU located? If the owner is responsible for external trap pumping, provide the Name, Address and Telephone Number of the property owner below: Property Owner's Name: Property Owner's Address: Property Owner's Telephone Number: Yellow Grease Waste Do you store yellow grease waste from fryolators? Where is the grease storage unit located? How often is this grease storage unit emptied?_ Please list the vendor who removes the waste: TOWN OF MANSFIELD LOCAL BYLAWS The following bylaws apply to all food establishments permitted by the Mansfield Health Department: Plastic Waste Reduction; Polystyrene Container Reduction; and Plastic Straw/Stirrer Reduction. A copy of each bylaw is included. It is the responsibility of the applicant to read and understand all bylaws. Please indicate by initialing the following statements that the permitted food establishment will adhere to all applicable bylaws. The applicant and associate corporation are subject to fines associated with violations. Plastic Waste Reduction No retail establishment in the Town of Mansfield shall provide thin-film, single -use plastic check-out bags to customers. I have received a copy of the Plastic Waste Reduction bylaw. I understand my responsibility to ensure that this bylaw is adhered to at the permitted food establishment. I understand violations of this bylaw will result in fines. Polystyrene Container Reduction (effective January 1, 2021) Food establishments are prohibited from dispensing prepared food and drink in disposable food service containers made from expanded polystyrene. All food establishments are strongly encouraged to use reusable food service containers and cutlery, and when possible biodegradable, compostable alternatives. Compostable materials must meet ASTM (American Society of the International Association for Testing and Materials) Standards for compostability. I have received a copy of the Polystyrene Container Reduction bylaw. I understand my responsibility to ensure that this bylaw is adhered to at the permitted food establishment. I understand violations of this bylaw will result in fines. Plastic Straw/Stirrer Reduction (effective January 1, 2021) Plastic beverage straws and plastic stirrers shall not be used or dispensed or sold except upon request in conjunction with the serving by business establishments or at any town -sponsored event of liquid, slurry, frozen, semi -frozen, or other forms of beverages to the public for consumption. L_1�I have received a copy of the Plastic Straw/Stirrer Reduction bylaw. I understand my responsibility to ensure that this bylaw is adhered to at the permitted food establishment. I understand violations of this bylaw will result in fines. Applicant Signature Applicant Name (please print clearly) 1E 1,a ``2(/T (2 C3 NOTICE TO EMPLOYEES NOTICE TO EMPLOYEES The Commonwealth of Massachusetts DEPARTMENT OF INDUSTRIAL ACCIDENTS LAFAYETTE CITY CENTER, 2 AVENUE DE LAFAYETTE, BOSTON, MASSACHUSETTS 02111 617-727-4900 - http://www.state.ma.us/dia As required by Massachusetts General Law, Chapter 152, Sections 21, 22 & 30, this will give you notice that I (we) have provided for payment to our injured employees under the above -mentioned chapter by insuring with: MA Retail Merchants WC Group Inc. NAME OF INSURANCE COMPANY PO Box 859222-9222, Braintree, MA 02185-0000 ADDRESS OF INSURANCE COMPANY 014000501929120 01/01/20 - 01/01/21 POLICY NUMBER EFFECTIVE DATES HUB NE Association Programs 300 Ballardvale Street, Wilmington, MA 01887 0 NAME; OF INSURANCE, AGENT ADDRESS PHONE # Honey Dew Donuts 99 Copeland Drive, Mansfield, MA 02048-0000 EMPLOYER ADDRESS 01/15/2020 EMPLOYER'S WORKERS' COMPENSATION OFFICER (IF ANY) DATE MEDICAL TREATMENT he above named insurer is required in cases of personal injuries arising out of and in the course of employment to lunish adequate and reasonable hospital and medical services in accordance with the provisions of the Workers' .ompensation Act. A copy of the First Report of Injury must be given to the injured employee. The employee may elect his or her own physician. The reasonable cost of the services provided by the treating physician will be paid by ie insurer, if the treatment is necessary and reasonably connected to the work related injury, In cases requiring ospital attention, employees are hereby notified that the insurer has arranged for such attention at the IAME OF HOSPITAL ADDRESS TO BE POSTED RV FMPIr "V-vu n o Q yd V) N 0 N 0 w 0 w W V z uz L z P4 EA u�) 0 < o ry a a az, v m m O a \i V z�,QQ h L 966L-9££-809-1 ezzemid ueydeiS db9 £0 OZ Co AeN I O O d © O 1 y O y jra 1 WW n N O � o 0 0 •� (�" o ap tzo " E "4 1 CO a cfi ' co bO q y I. i~ f \� )0 $� ~ f &] ƒ± \ 2 y » _ }) } 0\ ƒ \ _ ) \ § © ƒ - *4 \ ) \ Lij )) J® • es: / ZCD a \ } ui w- j) \) LU \ I ! 'SUPPORT American y ar' � Heart Association, Stephen Provazza has successfully completed the cognitive and skills evaluations in accordance with the curriculum of the American Heart Association Basic Life Support (CPR and AED) Program. Issue Date 1 1 /5/2019 Training Center Name Safety Program consultants Training Center ID MA04688 Training Center Address 28 Willlams Street Rehoboth MA 02769. USA Training Geriter Phone Number (508)252-3049 Recommended Renewal Date 11/2021 Instructor Name Ken Marcotrigiano Instructor ID 09060168685 eCard Code 195508479492 4�R:Code Q. . To view orverily authentirity, students and employ,,, shoultl scan this QR coda with their nmbile device or go to www.heart.org/cp,/,y,arda tW' 2016 Ampriaan Head Association, All riahls rasorvod. 15-3001 3110 m R � � 0 4--j � 3 Q » _ m � Q c \ � / % Cl) v m 4 2 \ \ % cq w k 27 U e @ \ @ c § }3 2 ƒ \ ? � Kai e / \ � d& / --.—.1 DONUTSH007 CWOODSIDE CERTIFICATE OF LIABILITY INSURANCE DATE A E(sYI l2o2o 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 ,.'ov„�., ,r ....v...... iUI3 International New England 300 Ballardvale Street Nilmington, MA 01887 INSURED 1, (9781 661.6915 PAX N.. INSURERtS) A_FFORDING COVERAGE NAIC4 INSURER A Hartford Insurance Group__ �914 _ I INSURERS Honey Dew Donuts INSURER C' 284 President Ave Providence, RI 02906 INSURERD INBURERE: INSURER F: P^%faDAnne f`GOTl Mlr`ATC M111Ra01=10• 131=\11.1 ILI .... Gv. 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, AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _EXCLUSIONS INSRT -- - - - ---- -FADDL SUBRr- - - — - - - - l POLICY EFF POLICY E%P — - - -- - -- - - - - -- - - - LTR TYPE OF INSURANCE INSp I yNp POLICY NUMBER p LIMITS A I X i COMMERCIAL GENERAL LIABILITY 2,000,000 DAMAGE TO RENTED CLAIMS -MADE ! X occuR 108SBAAD1921 - 4/23/2020 4/23/2021 1,000,000 pREMisEs (Ea ogwrren�_ $ . MED EXP IAn�one person)_ t $ 10,000 _- ... _� _. i PERSONAL$ADV INJURY_ 2000,000 GENL AGGREGATE LIMIT APPLIES PER, li �$ j GENERAL AGGREGATE 4,000,000 �_ _ POLICY _ , LOC I JE� , PRODUCTS-COMPIOP AGG _ $ 4,000,000 OTHER: A AUT OMOBILE LIABWTY �.. ''... COMBINED SINGLE LIMIT 2,000,000 F(E"MaK4). $ _. ANY AUTO 08SBAAD1921 4/23/2020 4/23/2021 BODILY INJURY Lerporsou)_ I$ OWNED SCHEDULED -- --- i'AUTOSONLY AUTOS H RED NSN-OINNRL BODILY INJURY Per accident ( ) PROPERTY DAMAGE $ - -- X X A�TOS ONLY A TOS NL 00 (PeraccitlenQ $ $ UMBRELLAIAB OCCUR. '�, EACH OCCURRENCE $ AGGREGATE XC EE99 LIAe i CLAIMS -MADE! III $ _—_ ___ DED 'i. RETENTION $ $ WORKERS COMPENSATION � PER OTH- :.STATUTE N YIN I ANantlatoM%ER H ER_ I ANY PROPREIETggORIPARTNER/EXECUTIVE '' EXCL DE IN/ FICEPJM M ER EXCLUDEDE I E.L.EACH ACCIDENT -. _ ___ $ I N l rY ) 1 Byes,dIPTION under 'I E L DISEASE - EA EMPLOYE $ I DESCRIPTION OF OPERATIONS below 1 E.L. DISEASE -POLICY LIMIT is A Commercial Property 108SBAAD1921 4/23/2020 4/23/2021 Bulid ingl6PP Blanket 1,137,449 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES 1ACORD 101, Additional Remarks Schedule, maybe attached if more space Is required) Building/Business Personal Property Blanket Limit Covering Locations: Honey Dew Associates Inc. as additional insured on all locations Loc #8, Bldg #1, 99 Copeland Dr, Mansfield, MA, 02048 CFRTICICATF LIn1 IIPI? r`AurCI I Anna SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Mansfield THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town Hall Mansfield, MA 02048 AUTHORIZED REPRESENTATIVE AGVKU Zb (Z01e/U3) U 1988.2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD