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HomeMy WebLinkAboutSunoco 12/31/2016Commonwealth of Massachusetts Town of Mansfield Board of Health Permit to Operate a Retail Establishment Town of Mansfield 6 Park Row Mansfield, MA 02048 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:. SUNOCO, INC (R&M) Whose place of business is: SUNOCO #6035 70 COPELAND DRIVE Permit Expires: December 31, 2016 License Number: RF -54 Food Fee: $67.50 Milk & Cream 0 BOARD OF HEALTH NichaecmcCCean, 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: SUNOCO #6035 70 COPELAND DRIVE License Number: RF -54 Permit Expires: December 31, 2016 BOARD OF HEALTH NichaeCNcCCean, Chairman Commonwealth of Massachusetts Town of Mansfield Town of Mansfield 6 Park Row Mansfield, MA 02048 Board of Health License to Sell Milk and Cream This is to certify that: SUNOCO, INC (R&M) having a place of business at: SUNOCO #6035 70 COPELAND DRIVE in the Town of Mansfield has been granted a license to sell MILK and CREAM and is subject to the Provisions of the Laws of the Commonwealth of Massachusetts, relating to the terms and conditions, and to the rules and regulations established by the Board of Health, of the Town of Mansfield governing the sale of Milk and Cream and shall remain in force until 1213112016 unless previous to that time is suspended or revoked. Expires 12131/2016 License No.: RF -54 Scott Leite, Heaah .Agent POST THIS LICENSE IN A CONSPICUOUS PLACE This license shall not be sold, assigned or transferred FOR BOARD OF REALTH USE ONLY 1`00D ESTABLISHMENT PERMIT AF=L1Ct`�Tl(DN ?'Jarrl'B sul4oco 100 S --- . =I( j I I , 1 --. 7 0 COP, LAND CHOWE MER-!,-DfAfJ- FILVD., SUITE ZACl Valli pf7jF�s -tint ON 10 ilwyemmsING, PA I -'sia) ,® � & NAT.H , Al� PA 19b ON V MER1,01AN BLVD, SUITE 2A01 i W TY l I I- -, SIJNOGO, MC (RM rit frr spp"C' rWi ONE PAERICLA-M B-LVC., ST 2A011 WYC]MIESSMG, PA 19610 Ca � -:��,vokoi �: - -1 1 9 OR -26 xner s" -fin 11L f V A Quf p� 3 -9 All I tt C -K--Ay Rv:s-rv, JOSEP H' BURRO U GUS, STORE, MAN"MGER 70 COPELA DWIVE, MANSFIELD, VA 01 0 --644 SCAOCZ; 3 Cls'A'If 24 t -E & 1-,, J0,e $CARAMOZZ-V'44�, ARE -J' -MANAGER h 7 7 4) 2 -:3 0 - 1 5 1 Food ELablfisklm; ent Infcormation l4il =`iATE I TO AN I 1 5 "1 1-3 J�,-GE MICFICY-��;141'1 TOWN lovair I a — ,-,;v (i F m 0, D T, BURROUGHS 18' N a me of r-lul-Z (I ch"I —t- C A Vrinager JOSEPH twl zl - va Is ark ris C, t, I �1, ( " " N, - I Twi 04 4 f- A,ft - " r iVf;r I k` e 3 1 fof, :.0 ;�., ;,I 'f ffir �N-, _- p �, r -.4 1 - �-� I I "t 2 of Fe --,n T-; _.roily ars L Ye trrro �e,.-n 450 11:? Sr' rf,�,tf - 7'r� Sl 7 v471 :if pul 5 tit's —s:. -517 74, 0 hid= n g o —r i q I -,-j 4 H —�F &.1 Nlor- ta Fuc4l RNA C -ztno 'm =-,zr �-4 t', f Ve * e 11-, h n a �v MXI q I lm Q! p --til t-7 La�py HACCI' KOO -'�Iz Re"all Sa,e Rlr =VIF 13JR Zllr.L I Ewl 70 be r"m Boartf of A bri r, V px, 4--vj J'j Q, -�t- 21 v! �tzk. red PO 23-17 41-1- Ci�f—a� Nar Sunoco,inc. (RQ M) Application r ARM an d Cream Permil 7awn ofManSfit 0—cl, Maimsilvid, VA 02448 . , - - �, I . . - �%S- o e pir �-eieb f T'V A Y 4�pl � N Cii"EA.M -&ERW" � wrdQ' f �� NAME OF BUSINE W 5 t I RICC', 960' -11; AV-D,Rki-5& 70; CC -FE: LAiND UR 'tE TELEPHONE AT LOCATION: i,:-: )-�,�2-S-rl I - C, - 1 -� FAA NUMSER: O'KNER OF BUSINESS: SUNOCO, INC ;F -&M) TELEPHONE OF OWNER: 68-2619 Oeu FEDE-RAL ID!SS NUhTSER' SVRMEKMM��� SIC,NATURE: 16108333501 sur:oco 12:18:45 p.m, 04-20-2016 1/2 -p 7 ivn o- :A7an ' eld : Bocird cit !`1'ealth n*.RAv,r NUMM RF -54 Town or Mansirmfd 6 furl, RQw Mamroold, MA W= Application fiar the Sale of 7obt eco t'e'e ducts I h&eby make aw, ALn for a p=r -A to self tzt�&= products :1 c.1MPHanra lV th(t Sca:d t¢ �1 lul fzagli on Affi�mx) Sme-fang a'tJ t*v Safe, VeTiling and D:�Iyjt w of %ban , This pe -mg exFtreR on Am-- 151.1 of e�:j. yw* 'p 41d1liur► V tt Regulation ray result in fi� , co irev' = e trtts pet6l- NAME Of BUSIN! : aw�5:; LOCA71110N OF Si" OF TOBACCO PROOUCTS: 70 COPE* P -M f)1 IVE TELEPHONE fig?' !LOCATION; X-8) 334-23.11 O'dYgEROF BUSINESS. �-� Sw"ge o 0•c+a-,\ LLC ADDRESS OF OWNM,_ :�~ Sf�I�-� : � ; :�T€ � re"�" T�� i3F.ir.. r�� One Nlaridian Blvd, Suite 2AT7 Wyomissing, PA '113010 IELEP HONE OF OWNER: {- 9CJ !9ii1-21119 011-2620 FAX NUMBER, =04.1�1 339-oeillai Is s -=�niton w;--aAnwihia_ :iie nv e, titin, and home 9dvess ol! oltars €; palwee U=,A4 .Atl IAC"= ' Provide a copy of current Dopartaient orRavanuo CINT Retail 15xcisir Unff Ucelss ee FEE: SILL 1 CT3T NUMBER. 03-73-. FEVERAL IDISSINUMBER: 23-7174328a 91G(�A1rtJFiEx �.�,�,,✓���"�i� DATE-: V5 5�j r, 'Tewn of Mansrield I fie dth Tolvri 6 parx R -ow Vansfieto, MA 02 M- PER*',,-TNUM 1KP.- R,F-54 Applica rkm fir the Sale t�f Tohacca Pro ditcr� .6 In rnp a � 1.i&� f I t-7 m a k c n0 - �5e-'.a t -i zl� i'i for a Lo s u c Cr P r C - u' t h t2 3 c� i fj I i R L smc':1 t�,,L- Sdlu, :)ndrtritcoil 0 -7, rI)CO' i- -- C- t'(?VOrOK Cwl f0%, IRI flt-t NAME OF I3IJ5WF-$,5: LOr-ATION OF SAJ I - ,E OF TOBACCO PRODUCTS' 7QU;,Pi-;i-e—'40 DRIVE T`ELEPHVNE AT LOCATION' � 5-t 8,1 S 3 9 - 2 3 ��" 1 Qwlt-ER OF Blah -stirlo()� INC, "J A k1j) Sunoco Inc. (R&M) ADDRESS OF 01KNER, One Meridian Blvd, Suite 2A01 Wyomissing, PA 19610 TEL E,PHONE OF OWNER: FAJ( NUIVIUVW ii �nirc%oraton o - tit, ke, -�:' rd h :, m a Ei ccwe-s 5 �zi f 0 C f S -Y 0 J Ifn a r, 1p. 997491 SF"ZF a�wvcj lcb Provide a T copy of curroof DepoAment orRevionve CT�3Retail Excist Unit Licensv, CT -3T NUMBER' FtOtHAL ID?S3 NUMBER: i2l- - f�-13283 SIGNATURC, 7 DATE: g[oz-oz-vo 'w'd 8Z:GL:ZL o:)ounS LOSEEEBOM V— C4 0 N .0 CO §� § { u C4 al co 03 � k b {� . � , / � Q tn r C3 Z Ecq)k§U 0 0 on L) \\\ zi wz f, Z) 0 "E22 Z a]. u VID d) it CL. 0 CD 4- 0 c ell C 0 0 d) Vol LL (n W ILI: tj til tv 04 2, P z C3 tu E CD in 0 & 0 CL < 0 IL z :5 E »zap 0 E2 U)ca ILI 0 t. Z UJ z cl: M . Z w 0 g[oz-oz-vo 'w'd 8Z:GL:ZL o:)ounS LOSEEEBOM I cerlff� lumd':, the pestes of Pe that 1, my best �Xlvwledqe a7ld L.Wj"�c-f ,-,rvO r1joij -j Statu lax rezorns anj oald, all S!a'a laxe law, jividuai cr cufpmjti� Name rptlamaloryi .Soul Secj6ty Nurnber FedefW ldentffic��bon Wniber Th&S license wili not be issued unless LIT -e certifigavon cjau�ve is signod by me applicant. — y ;,- i Sf,- ov u r iry rum b +,- r. b a fu r r, ishv d 10 t hM a " 0 Chi s a S '�'vzaIg aepar1r1l,arit oll Revem.� to detefrm-,,whether yOU met tax ff Or tax P-Tirle-M WFgations, Uzenseea'si ititpo fail to co-rrac 7t zr deGrp uericy: Is tcquet made, U-C"e'r be J,Ubjezt* r.�G licemss e- uspenjkan c, tion, Th' �t is i�2(;, sv�ct;on 49A t-va authority of TvTusz, Out, 4- Y QQW Cam pemaho a In-skirance A Rids it AnerW A A atsits Rik -t I "A f Ile a to;: Pr- r jjjn; tt 1124, LtLiZ- ;jjhh2 j1h, Sunoco Inc. (R&M) —""One-MOidian Blvd, Suite 2A01 Wyomissing, PA 19610 MAW1/0 All! 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Cop�jG'0.1 ,, vhwt ;: AAW - — fire o 0# fraj-1 j!'eitif M4 02111 jzo lvdia Y QQW Cam pemaho a In-skirance A Rids it AnerW A A atsits Rik -t I "A f Ile a to;: Pr- r jjjn; tt 1124, LtLiZ- ;jjhh2 j1h, Sunoco Inc. (R&M) —""One-MOidian Blvd, Suite 2A01 Wyomissing, PA 19610 MAW1/0 All! JYw-- "ni uwpbjnqQH ari "all a Vic PUT- V 1 " pAt ill 1 01 WA Am 11 45M hy 4 [g i*'�"d 0i L -1, ",Z-- 9 V-1 r,, N4 t w u v w: or ivur7� I I ' 1 5: o awyN 1 ma 1 IN aw ki' 13;Rp, 1, 1 Logo Cc 1 HwAMCS1 Qpp (req24"Q 1 U wK2 WT; You Ynd umun -'� 6ol 3. 1 ] "0 1 F1 , - � , 10 1 VIAWWL y- plaw In Own, Nlw� PC b(kb:C, 133 (SAWK INEMM Q! wy "i 9 i Am s. L w 147 V :59 K3 q 15' AMM43 aqW010C w rAmpmmwfiam Kwy *WMAMP page (showwAtopq the poky awatbtf- **d rrpk*Ne- a dalt), Vc % q U I : t -' I C C. 1.1 Z14 ly M: fftiar eF w j I SIP (;.`.,$ r j- n i Vein w a n n t STOP M A ORDER wd pr~':� Iphn Andivooddru djp*qN q Ows Me promJij 21mvv h fr6e, a,qid cofr?%' r, thMa! mc onin JXx n4 wdM A ih-,� aretir, e�l a.e r vi -Y r`p "v- -, qjh'ir"J Mot Ir -no lnudug kwkupty wasic L UnaFd,4 I IrANh Z U-MUhpanw-r( ily "Fu o' r, 4- 4 rL 4, 1- i�i 'w=flq_e 13��wr j 5. 'S"k lvt at, § UrM-e -' Olhzr . Cop�jG'0.1 ,, vhwt ;: AAW - — Sunoco, Inc. (R&M) flareTitle I Expires On ' Tenn Archer, Cynthia A. Vice President 12/3112999 Perpetual Dodderer, Arnold D. General Counsel 8 Secretary 1213112999 Perpetual Donnelly, hlarci K. Assistant Secretary 12/3//2999 Perpetual foster, Boyd E_ Vice President 12I31f2999 Perpetual Green, Patricia J. Vice President /213/12993 Perpetual Heinemann; S Blake 'Vice President 1213112999' Perpetual Hess, Sheryl L_ ':rice President /2/3112999 Perpetual Owens, Robert W. President 1213112999 Perpetual Owens, Robert W. Sole Director 1213112999 Perpetual Scarpa, Joan Vice President 12131f2M ` Perpetual Steel, John P. Sake President /2/3112999 Perpetual Wagner, James F. Vice President 1213112999' Perpetual Williams, Anthony M. Vice President 12/3112999 Perpetual 0112712016 Page 1 of 1 16103592528 11:07:33 a.m. 09-11-2015 112 CERTIFICATE , LIABILITY INSURANCE PATE {,uwomYY) 9n5n_DI6 913/201 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 INSURERS), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT, 11 Um cardflcals holder Is an ADDITIONAL INSURED, the poilcy(les) must be endorsed. It SUBROGATION IS WAIVED, subject to the forms and conditions of the policy, certain policies may require an endorsement A statement cm this Certificate does not confer rights to the Certificate holder In Iau of such andorsament(sj. PRODUCER LOCKrON COMPANIES 5847 SAN FEUPE. SUITE 320 HOUSTON TX 77057 866.260 3538 y y INSURER A i Old Roublic InsurancoQawny7 INSURED SuromInc $M} 1389322 17351Ai ht SSAhe1e01103 Plillade B; ERC: JtTEO ml S M000,11) 0 AED EXP (Any we p =) 9 XXX XXX PSISONN. A ADV INIURY S 10,000,000 OENLAGGREGATE LINT APPLIES PER POLICY13 M ® LOC OTHER COVERAOES CERTIFICATE LIM NU 'M THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERI0 INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT 70 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 ""u POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Mv TYPE Of INSURANCE POUCYNUYBER IY LUATS A x COAI,AFRCIAL GENERAL LIABILITY cwA64AWE©OCCtAi y y NIWZY 59829 15 9115/1015 9115/3016 5 10.000 000 JtTEO ml S M000,11) 0 AED EXP (Any we p =) 9 XXX XXX PSISONN. A ADV INIURY S 10,000,000 OENLAGGREGATE LINT APPLIES PER POLICY13 M ® LOC OTHER bowmAcoReGATE s 111/1110000 PROOUCTS • COWOPAGO s 10.000:000 It A AUTOMOBILE LIABUTY X ANYAUTO 10 AU �p�JIINID ��p13�� MREOAUTOS AUTGSWNED j{ McS•90 Y Y M71331711 31711 l5 9/15/2013 9/15/-016 � L uA,t s 10 001? 000 BODLYINA,RY(Perpe(w) s (}d{ BODILYINAW(Paseddem 3 )000Q(}(J( E i s }{ E7aCESSILAB OCCUR LAI CWMSAIADE NOTAPPLICAHIE s XXXXXXX AGGREGATE s X)000= OED 1 1 RERMONS It A ANOEJAPI.DYEgP-MTL, BMJrY YIN ANYMOPMErOFMATIARIDICIANTO tN.,dMarinlnl, 'o 00MAtIO" NIA Y MWC 11793915 9115/2015 9n5n016 X A T ELEACHACCICNT s 1010M.000 ELpsws•aAELPLOYefi 10,000,000 10(00000 A 'E:ceaWmkcrsCcvmwton N y MWXS300313IS 9115/2015 9/15/2016 ELEuhAcc5t0VN t SIOMM EL EL Diu3te•EschrMtt S IDhIM DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES tAttach ACORD 101, Add,Uand Remarks Sdwduls, msy be MUched It roan apace Is regrind) EXCESS WORKERS COh1PENSATION -' POLICY APPLIES TO STATES: PA, OK OH, Ml, NM. All policies (except Worken' CompatsnttonMLj contain a special endow,= I with "Primary and Noncontributory" warding. 12534321 For nfOtTRailonal Purposes Only OK SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE UPIRAT10NCATE THEREOF, NOTICE WILL BE DUMMER IN ACC WWANCEV»MNTHEPOLICYPROMoNS. AP L The ACORD name and logo are registered marts of ACORD dahtn 16103592528 11:08:13 a.m, 09-11-2015 212 All policies (except Workers' Compensation/EL) Include a blanket automatic addition) Insured endorsement [provision) that confers additional insured status to the cerUficate holder only If there Is a written contract between the named Insured and the certificate holder that requires the named Insured to name the certificate holder as an additional Insured, in the absence of such a contractual obligation on the part of the named insured, the certificate holder Is not an additional Insured under the policy. All policies include a blanket automatic waiver of subrogalion endorsement [provision] that provides this feature only when there Is a written contract between the named insured and the certificate holder that requires It. In the absence of such a contractual obligation on the part or the named Insured, the waiver of subrogation feature does not apply. Miscellaneous Attachment : M490201 Master ID: 1389322, Certificate ID: 12534321