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Home My WebLink AboutRIbiero Enterprises, Inc. 12/31/2018Commonwealth of Massachusetts Town of Mansfield Town of Mansfield 6 Park Row Mansfield, MA 02048 Board of Health Septage Pumping and Transporting Permit i This is to certify that: DYLAN RIBEIRO Doing business as: RIBEIRO ENTERPRISES, INC. 133 MANSFIELD AVENUE NORTON MA 02766 is hereby granted a SEPTAGE PUMPING AND TRANSPORTING PERMIT to engage in the pumping or transporting of the contents of privies, cesspools, septic tanks and other offensive substances. This permit is granted in conformity with the STATE ENVIRONMENTAL CODE. 310 CMR 15.02(2) and MGL chapter 111 section 31A and expires December 31, 2018 unless sooner suspended or revoked. LICENSE NUMBER: 16 TRUCK REGISTRATION NUMBER(S): R83212 BOARD OF HEALTH MichaeCAcCCean, Chairman Town of Mansfield Town of Mansfield - Board of Health 6 Park Row Mansfield, MA 02048 Septage Pumpers Application BUSINESS NAME: RIBEIRO ENTERPRISES, INC. MAIL ADDRESS: 133 MANSFIELD AVENUE TOWN: NORTON STATE: MA NAME OF OWNER: DYLAN RIBEIRO BUSINESS TELEPHONE: (508) 397-1263 E-mail: DYLANRIBEIRO@YAHOO.COM FED ID/SS NO: 04-2272510 REGISTRATION NUMBER(S): FEE PER TRUCK: $75.00 LICENSE UMRER;A6 ! , NOV 09 2017 vw ZIP CODb"k;_A27$6—____.__ .. CELL: Alt E-mail: NUMBER OF TRUCK(S): 1 R&32 5 FAX: (508)285-3168 Please make appropriate changes. Sign, date. and enclose check payable to Town of Mansfield. Mail to: Board of Health, Town of Mansfield, Six Park Row, Mansfield, MA 02048. SIGNATURE DATE: L t l TRUCKS INSPECTIONS: DATE: THURSDAY NOVEMBER 9, 2017 TIME: 7:30 AM - 10:30 AM PLACE: FOXBOROUGH DPW PARKING LOT, 70 ELM STREET, FOXBORO PLEASE BE THERE, OR CALL THE FOLLOWING NUMBER (508) 261- 7366, IF YOU CAN NOT MAKE THIS DATE FOR HEALTH AGENT'S USE ONLY 310 CMR: State Environmental Code, Title 5; Minimum Requirements for the Subsurface Disposal of Sanitary Sewage. i5.502 Transportation and Disposal of Privy, Cesspool, and Septic Tank Contents. 15.505 Equipment: No person shall use equipment to remove or transport the contents of prives, cesspool, or septic tanks or other offensive substances unless such equipment has first been inspected and approved by the Board of Health. A. Mobile Tank: XSecurely mounted on truck Watertight X Leak -proof cover Tight discharge tanks I _ A Acceptable NA Not Acceptable B. Venting of Mobile Tanks: Vent permits escape of gas, but not liquid C. Hose: X Suction or pressure hose in good repair D. Pumps: Maintained to prevent leaking of sewage Inspected by: Inspected on: \\Icy 1 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: orpo to 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. CERTIFICATE OF IJAB' ILITY INSURANCE DATE(MWDDNYYY) 11/1612017 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($), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, IMPORTANT: If the certificato holder is an ADDITIONAL INSURED, the policy(ies) must 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 -��—w Partners Insurance Group, LLC 560 Wilbur Avenue Swansea MA 02777 NFAOr NAME: Maria Ariuda PHONE FAX ac N508-491-3 76 ac Ne:508 9 -3108 A Ress:MA ruda ersins r Ilc.com INSURERS AFFORDING COVERAGE NAIC,7 INSURERA :NGM Insurance Company4788 INSURED RIBEI-2 INSURER B : INSURER C : Rlbel(O Enterprises. Inc. Dylan J. Ribeiro P.O. BOX 455 INsuRER D Norton MA 02766 INSURERE: NSURER F : COVERAGES CERTIFICATE NUMBER: 1845711359 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 OF, 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 LTR TYPE OF INSURANCE DDLISUISR INSR "Are POLICY NUMBER MMID�Y EFF MWDD EXP LIMITS A GENERAL LIABILITY X COMMERCIALGENERALLIABILITY CLAIMS -MADE a OCCUR MPT2783C 10/4/2017 10/4/2018 EACH OCCURRENCE $1,00g000 DAMAGE TO RENTED PREMISES Ea occurrence $500,000 MED EXP(Any one person) SIOD00 PERSONAL &ADV INJURY $1,000,000 GENERAL AGGREGATE S2,000,000 GEN'L AGGREGATE X POLICY LIMIT APPLIES PER: PRO LOC PRODUCTS-COMP/OPAGG $2,000,000 $ A LIABILITY ANY AUTO ALL OWNED X SCHEDULEO AUTOS AUTOS NON -OWNED HIRED AUTOS X` AUTOS M1T2783C 10/4/2017 10/4/2018 COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $500,000 PAUTOMOBILE BODILY INJURY (Per accident) $1,000,000 PROPERTY DAMAGEm Perdent $ A X UMBRELLA LAB EXCESS LV\B X OCCUR CLAIMS -MADE CUT2783C 10/4/2017 1014/2018 EACH OCCURRENCE $1,000,000 AGGREGATE $1,000,000 DEB X RETENTION$10,000 $ A WORKERS COMPENSATION ANDEMPLOYERS'UABILITY YIN ANYPROPRIETORMARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N❑ (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA WCT2763C 11/10/2017 11/10/2018 i -•- WC STA'N- OTH- E.L. EACH ACCIDENT $500,000 E.L. DISEASE - FA EMPLOYEE $500,000 E.L. DISEASE -POLICY LIMIT $500000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarles Schedule, If more space is required) 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 - n 1988-2010 ACORD CORPORATION_ All rights ACORD 25 (2010/06) The ACORD name and logo are registered marks of ACORD Town of Foxborough Town of Mansfield Town of Norton 310 CMR 15.505 SEPTAGE HAULERS INSPECTION REPORT PERMIT#; DATE: 11/9/2017 Paid: Y First Tri-Town Inspection Day COMPANY NAME: ' bc, % ADDRESS: TELEPHONE#: OPERATOR: TANK CAPACITY: V� TRUCK LIC. NUMBER: 'B Equipment �J 1. Mobile Tank (securely mounted on trucks, watertight, necessary odor controls, leak -proof cover, tight discharge valves) 0d-2. Venting (gas) of Mobile Tank (properly constructed) Suction or Pressure Hose in good repair 4. Pumps (leak -proof) This vehicle i in compliance with 310 CMR 15.505. Person Interviewed I spector (2017)