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Home My WebLink About2018-08-13 Board of Selectmen Minutes BOARD OF SELECTMEN MINUTES August 13, 2018 CALL TO ORDER: Chairman Regina Kean called the meeting to order at 7:OOPM in the Town Hall Meeting Room. The open session meeting was recorded. ATTENDANCE: The following were present: Chairman Regina Kean, Clerk Phil DeCologero, Licensing Chairman, Chris Nobile, Richard Vaillancourt, Rosemary Smedile, Town Manager Andrew Maylor and Assistant Town Manager, Ray Santilli. PLEDGE OF ALLEGIANCE PUBLIC COMMENT: Stan Limpert of 43 Stonecleave Road, asked Chairwoman Kean to allow public comment at the end of the meeting. Samuel Campana of 37 Grosvenor Avenue asked the Board to stop work by National Grid gas until the lockout is over. Karen Lauro of 591 Mass Avenue spoke about the Mass Avenue project and her concerns that they are damaging her property. INTRODUCTION OF NEW STAFF MEMBERS Nabil Daher, Electrical Inspector Nabil Daher, the new electrical inspector, introduced himself to the Board. APPROVAL OF MINUTES: Richard Vaillancourt made a MOTION, seconded by Chris Nobile, to approve the Open Session Minutes of July 16, 2018. Motion approved 5-0. ACCEPTANCE OF DONATIONS From Wheelabrator in the amount of$10,000 to be used to pay the user agency fee for Trauma Intervention Program services in North Andover Once again, Wheelabrator has agreed to donate $10,000 to cover the cost of the Town's user agency fee for Trauma Intervention Program services in North Andover. Phil DeCologero made a MOTION, seconded by Chris Nobile that the Board of Selectmen accept the donation of$10,000.00 from Wheelabrator to be used to pay for the Trauma Intervention Program. Motion approved 5-0. From McDonald's/Lietz Family in the amount of$2,000.00 to be used for equipment at the Youth Center The Lietz Family, owners of McDonalds donated $2,000 to the Youth Center. Richard Vaillancourt made a MOTION, seconded by Chris Nobile that the Board of Selectmen accept the donation of$2,000.00 from McDonald's/The Lietz Family to be used for equipment at the Youth Center. Motion approved 5-0. LICENSING COMMISSIONERS: Richard Vaillancourt made a MOTION, seconded by Phil DeCologero to open a meeting of the North Andover Licensing Commission. Motion approved 5-0. John Nioroge of Crossway Transit, LLC requests a Livery License at 30 Mass Ave. Phil DeCologero made a MOTION, seconded by Richard Vaillancourt that the Board of Selectmen, acting as Licensing Commissioners, approve the request of John Njoroge of Crossway Transit, LLC for a livery license at 30 Massachusetts Avenue. Motion approved 5-0. Armen Jeknavorian of St. Gregory Armenian Church requests a one day wine and malt license for a picnic on September 9, 2018 from 12:OOPM-5:30PM and a waiver of the fee Regina Kean made a MOTION seconded by Phil DeCologero that the Board of Selectmen, acting as Licensing Commissioners, approve the request of Armen Jeknavorian of St. Gregory Armenian Church for a one day wine and malt license for a picnic on September 9, 2018 from 12:00PM- 5:30PM and to waive the fee. Motion approved 5-0. Board of Selectmen Minutes August 13, 2018 2 Change of manager request for The Stevens Estate Regina Kean made a MOTION, seconded by Richard Vaillancourt that the Board of Selectmen, acting as Licensing Commissioners, approve the change of manager request for The Stevens Estate. Motion approved 5-0. Paul Gallant of Merrimack College requests a one day wine and malt license for a reception at the Stadium Pavilion on August 30, 2018 from 6:OOPM-8:OOPM Rosemary Smedile made a MOTION, seconded by Regina Kean that the Board of Selectmen, acting as Licensing Commissioners, approve the request of Paul Gallant of Merrimack College for a one day wine and malt license for a reception at the Stadium Pavilion on August 30, 2018 from 6:OOPM-8:OOPM. Motion approved 5-0. Deborah Ingalls of Butlers and Bars requests one day liquor licenses for events in the tent at Smolak Farms: 1. All alcohol license for a wedding on August 18, 2018 from 4:OOPM-10:OOPM 2. All alcohol license for a wedding on September 2, 2018 from 4:OOPM-9:OOPM 3. All alcohol license for a corporate picnic on September 9, 2018 from 11:OOAM-6:OOPM 4. All alcohol license for a wedding on September 15, 2018 from 4:OOPM-10:OOPM 5. Wine and malt license for a corporate dinner on September 20, 2018 from 4:OOPM-9:OOPM 6. All alcohol license for a wedding on September 22, 2018 from 4:OOPM -10:OOPM Richard Vaillancourt made a MOTION, seconded by Regina Kean that the Board of Selectmen, acting as Licensing Commissioners, approve the requests of Deborah Ingalls for events at Smolak Farms as presented. Motion approved 5-0. Discussion regarding fees for one day liquor licenses Licensing Chair, Chris Nobile, explained it would be helpful to periodically review the fee schedule and whether there should be some fee for expedited processing for late applications. The Board asked for a comparison of fees from other communities and what is the total amount of yearly revenue received from the fees. The Town Manager explained there is a cost to process something in a shorter time period and it is a more difficult and challenging to process. Rosemary Smedile made a MOTION, seconded by Regina Kean to close a meeting of the North Andover Licensing Commission. Motion approved 5-0. CONSENT ITEMS: Approve and sign easements for MassDOT Mass Avenue/Chickering Road Intersection Project Included in the packets were documents required for the Mass Avenue/Chickering Road Intersection Project. DPW Director, Jim Stanford, explained the three easements and that there is no cost associated with the easements. Chris Nobile made a MOTION, seconded by Phil DeCologero to approve the easements for the MassDOT Mass Avenue/Chickering Road Intersection Project. Motion approved 5-0. Department of Public Works request to surplus vehicles and equipment Included in the packets was a request from Jim Stanford, DPW Director, to surplus certain vehicles and equipment. Chris Nobile made a MOTION, seconded by Rosemary Smedile that the Board of Selectmen approve the request of Jim Stanford, DPW Director, to surplus the vehicles and equipment outlined in his memorandum dated August 8, 2018. Motion approved 5-0. Accept Child Passenger Safety Equipment Grant from the Massachusetts Executive Office of Public Safety in the amount of$2,625 Fire Chief William McCarthy introduced Firefighter Jeff Deschenes and Police Sgt. Katie Gehrke who explained the grant they received from The Executive Office of Public Safety in the amount of$2625. Richard Vaillancourt made a MOTION, seconded by Phil DeCologero that the Board of Selectmen accept the grant from the Executive Office of Public Safety in the amount of $2625.00. Motion approved 5-0. Board of Selectmen Minutes August 13, 2018 3 Request of Joseph Contrada of Saint Vincent de Paul Conference for use of the Town Common on Saturday, September 22, 2018 from 10:OOAM-12:OOPM for the Walk for the Poor The St. Vincent de Paul Conference requesting permission to hold their annual Walk for the Poor on Saturday, September 22, 2018 from 10:OOAM to 12:OOPM. As it has been for the last two years, the walk will be at the same time as the Fall Festival. All relevant departments reviewed and have no issues. Phil DeCologero made a MOTION, seconded by Chris Nobile that the Board of Selectmen approve the request of St. Vincent de Paul Conference to use the Town Common on Saturday, September 22, 2018 from 10:OOAM to 12:OOPM for their annual Walk for the Poor. Motion approved 5-0. Town Manager appointment of Lori Crane as an associate member of the Planning Board The Town Manager has appointed Lori Crane as an associate member of the Planning Board. The Board was asked to support that appointment. Richard Vaillancourt made a MOTION, seconded by Phil DeCologero that the Board of Selectmen support the appointment of Lori Crane as an associate member of the Planning Board. Motion approved 5-0. Accept Green Communities grant from Department of Energy Resources in the amount of$173,783.00 The town has received a grant from the Department of Energy Resources in the amount of$173,783.00 to be used for the conversion of all town owned streetlights to LED. The project is scheduled to be completed by the end of the year. Phil DeCologero made a MOTION, seconded by Rosemary Smedile that the Board of Selectmen accept the grant from the Department of Energy Resources in the amount of$173,783.00. Motion approved 5-0. Sign warrant for the 2018 State Primary Town Clerk, Joyce Bradshaw, explained statute requires the Board to sign the warrant for the state primary on September 4, 2018. Richard Vaillancourt made a MOTION, seconded by Phil DeCologero that the Board of Selectmen sign the warrant for the 2018 State Primary on September 4, 2018 from 7:OOAM to 8:OOPM. Motion approved 5-0. Approve permit fees for town projects As discussed at the last meeting, included in your packets is a list of town projects that will require permits. The Town Manager is asking the board to waive the fees for all these projects. Chris Nobile made a MOTION, seconded by Phil DeCologero that the Board of Selectmen waive all fees associated with the projects found on the report submitted by the Town Manager. Motion approved 5-0. Appointments Christopher Jee-Affordable Housing Trust Justin Lafond- Neighborhood Conservation District Commission Michael Lis-Zoning Board of Appeals (associate member) Steve Seide-Zoning Board of Appeals (associate member) Patricia Riley-Council on Aging Jenna Sideri-Youth & Recreation Council William Swiggart-Stevens Estate Advisory Committee Derrick Ward-Sustainability Committee Martha Wolfenden-Historical Commission Rosemary Smedile made a MOTION, seconded by Phil DeCologero that the Board of Selectmen appoint all volunteers listed in the memorandum from the Town Manager dated August 8, 2018. Motion approved 5-0. Richard Vaillancourt recused himself and left the room. Request of Ashley Vaillancourt and Chris Buco to use the Town Common on August 30, 2018 from 6:OOPM-9:OOPM for end of season celebration for Summer Fitness Series Ashley Vaillancourt presented her request to use the Town Common for an end of the season celebration for the Summer Fitness Series. Ms. Vaillancourt is aware she needs to apply for a one day wine and malt license which will be on the agenda for the next meeting. Board of Selectmen Minutes August 13, 2018 4 Phil DeCologero made a MOTION, seconded by Chris Nobile that the Board of Selectmen approve the request of Ashley Vaillancourt and Chris Buco to use the Town Common on August 30, 2018 from 6:OOPM-9:OOPM for an end of the season celebration for the Summer Fitness Series. Motion approved 4-0. Richard Vaillancourt returned to his seat. Request of Brian Fraser of North Andover CAM for waiver of building permit fee for 70 Main Street Brian Fraser of North Andover CAM presented his request to waive the building permit fee for the build out at its new location at 70 Main Street. Rosemary Smedile made a MOTION, seconded by Phil DeCologero that the Board of Selectmen waive the building permit fee for North Andover CAM for construction at 70 Main Street. Motion approved 5-0. GOVERNMENTAL REPORTS Update on the September 4, 2018 State Primary from Town Clerk, Joyce Bradshaw Joyce Bradshaw gave an update on the upcoming State Primary which is September 4th OLD BUSINESS: None NEW BUSINESS: None TOWN MANAGER'S REPORT: Reports The Board was provided with the following monthly reports: Police, Fire, Opioid Overdose, Building and Job posting/vacancy log. The Town Manager explained that the Planning Board is going through the Draft Master Plan and have had two public hearings and will have one more. The draft will then be presented to the Board of Selectmen for comment on August 27th. The Town Manager recommended when the final plan is complete the Board may want to appoint an implementation committee. SELECTMAN'S UPDATES/COMMENTS Rosemary Smedile stated that she went to the Vietnam Wall ceremony in Wilmington which was very moving. Richard Vaillancourt thanked the Police and Fire Departments for National Night Out. Rosemary Smedile stated the Women's Club will be looking for the oldest resident in North Andover to present the Boston Post cane. Phil DeCologero announced the Artisan Club will be at the Mills on Sunday. Chairman Kean stated that the Old Center District Commission will be at the September 24th meeting and the Cultural Council will be at the meeting on August 27th to give an update. Chairman Kean also stated there is an Old Center Zoning Review Committee and their next meeting is Thursday, August 30tH ADJOURNMENT: Chris Nobile made a MOTION, seconded by Phil DeCologero to adjourn the meeting at 9:07p.m. Motion approved 5-0. Laurie A. Burzlaff Executive Assistant Phil DeCologero, Clerk of the Board Board of Selectmen Minutes August 13, 2018 5 Documents used at meeting: Minutes of July 16, 2018 Wheelabrator donation letter McDonald's donation letter Crossway Transit license request St. Gregory Church license request Change of Manager request-Stevens Estate Merrimack College license request Smolak Farms license request Licensing fee schedule Easements DPW surplus request Child safety seat grant letter St. Vincent use of common request Appointment memo Green communities grant letter State primary warrant Permit fee waiver request Appointment memorandum Vaillancourt use of common request NACAM fee waiver request Police report Fire report Overdose report Job posting/vacancy log Building report TOWN OF NORTH ANDOVER BOARD OF SELECTMEN 120 MAIN STREET NORTH ANDOVER, MASSACHUSETTS 01845 Regina Kean, Chairman /IIIY�%/ •.. Phil DeCologero, Clerk „� " TEL. (978)688-9510 Chris Nobile FAX(978) 688-9556 Rosemary Connelly Smedile Richard Vaillancourt BOARD OF SELECTMEN& LICENSING COMMISSIONERS AGENDA MONDAY,AUGUST 13,2018 7:00 PM OPEN SESSION TOWN HALL MEETING ROOM 120 Main Street L CALL TO ORDER IL PLEDGE OF ALLEGIANCE III. PUBLIC COMMENT IV. INTRODUCTION OF NEW STAFF MEMBERS A. Nabil Daher,Electrical Inspector V. APPROVAL OF MINUTES A. July Il6,2018 Open Session Minutes, as written VL ACCEPTANCE OF DONATIONS A. From Wheelabrator in the amount of$10,000 to be used to pay the user agency fee for Trauma Intervention Program services in North Andover B. From McDonald's/LietZ Family in the amount of$2,000.00 to be used for equipment at the Youth Center VII. LICENSING COMMISSIONERS A. John Nloroge of Crossway Transit,LLC requests U Livery License at 30 Mass Ave. B. Armen Jeknavorian of St. Gregory Armenian Church requests U one day wine and malt license for a picnic on September 9 20Il 8 from 12:OOPM-5:30PM and a waiver of the fee C. Change of manager request for The Stevens Estate D. Paul Gallant of Merrimack College requests U one day wine and malt license for a reception at the Stadium Pavilion on August 30,20ll 8 from 6:00PM-8:00PM E. Deborah Ingalls of Butlers and Bars requests one dUquor licenses for events in the tent at SmolUk Farms: 1.All alcohol license for a wedding on August 18,2018 from 4:OOPM-10:OOPM 2.All alcohol license for a wedding on September 2,2018 from 4:OOPM-9:OOPM 3.All alcohol license for a corporate picnic on September 9,2018 from 11:OOAM-6:OOPM 4.All alcohol license for a wedding on September 15,2018 from 4:OOPM-10:00PM 5.Wine and malt license for a corporate dinner on September 20,2018 from 4:OOPM-9:OOPM 6.All alcohol license for a wedding on September 22,2018 from 4:OOPM -10:OOPM F. Discussion regarding fees for one dE liquor licenses VIII. CONSENT ITEMS A. Approve and sign easements for MassDOT Mass Avenue/Chickering Road Intersection Project B. Department of Public Works request to surplus vehicles and ecuipment C. Accept Child Passenger Safety Equipment Grant from the Massachusetts Executive Office of Public Safety.m.the.amount of_$2,625 D. Request of jos�gph.Contrada of Saint Vincent de Paul Conference for use of the Town Common on SaturdU, September-22,201-8 from 10:OOAM-12:OOPM for the Walk for the Poor E. Town Manager appointment of Lori Crane as an associate member of the Pla!mjng_BjjEd F. Accept.Green.Communities grant from Department of Energy Resources in the amount of$173,783.00 G. Sign warrant for the 2018 State Primary H. Approve permit fees for townpEqjects 1. Appointments 1. Christopher Jee-Affordable Housing Trust 2. Justin Lafond-Neighborhood Conservation District Commission 3. Michael Lis-Zoning Board of Appeals(associate member) 4. Steve Seide-Zoning Board of Appeals(associate member) 5. Patricia Riley-Council on Aging 6. Jenna Sideri-Youth&Recreation Council 7. William Swiggart-Stevens Estate Advisory Committee 8. Derrick Ward-Sustainability Committee 9. Martha Wolfenden-Historical Commission H. Request of Ashley.Vaillancoult and Chris Buco to use the Town Common on August 30,20-1-8--from 6:OOPM-9:OOPM for end of season celebration for Summer Fitness Series 1. Request of Brian Fraser of North Andover CAM for waiver of building permit fee for 70 Main Street Ix. GOVERNMENTAL REPORTS A. Update on the September 4,2018 State Primary.from.Town.Clerk,.Joyce.Bradshaw X. OLD BUSINESS X1. NEW BUSINESS x1l. TOWN MANAGER'S REPORT A. Reports 1.Police 2.Fire 3.Opiate overdose 4.Job posting/vacancy log 5.hLiildln� XIII. SELECTMAN'S UPDATES/COMMENTS XIV. NEXT MEETING DATE Monday,August 27,2018 XV. ADJOURNMENT BOARD OF SELECTMEN MINUTES July 16, 2018 CALL TO ORDER: Chairman Regina Kean called the meeting to order at 7:OOPM in the Town Hall Meeting Room. The open session meeting was recorded. ATTENDANCE: The following were present: Chairman Regina Kean, Clerk Phil DeCologero, Licensing Chairman, Chris Nobile, Richard Vaillancourt, Rosemary Smedile, Town Manager Andrew Maylor, Assistant Town Manager, Ray Santilli and Executive Assistant, Laurie Burzlaff. Approximately 16 members of the public were present. PLEDGE OF ALLEGIANCE PUBLIC COMMENT: Gas worker locked out by National Grid that does not live in North Andover asked for a moratorium on construction work for National Grid gas until regular employees are back. Henry Wright of 70 Maple Avenue spoke in support of changing Columbus[day to Indigenous People's Day. The chair asked that any other public comments related to tate first consent item wait until that item is presented. APPROVAL OF MINUTES: Richard Vaillancourt made a MOTION, seconded by Phil DeCologero, to approve the Open Session Minutes of June 18, 2018. Motion approved 5-0. ACCEPTANCE OF DONATIONS From the Franklin School PTO in the amount of$1,000 to the Youth Center for summer equipment Franklin School PTO donated $1000 to the Youth Center to be used to purchase summer equipment. Richard Vaillancourt made a MOTION, seconded by Phil DeCologero that the Board of Selectmen accept the donation of$1,00000 from the Franklin School,PTO to be used for summer equipment at the Youth Center. Motion approved 5-0. From Viviane Delima in'tho-amount of$300 to the Police Department for any needed equipment or service The Police Department received a donation from Viviane Delima to be used for any needed services or materials. Richard Vaillan curt made a MOTION, seconded by Phil DeCologero that the Board of Selectmen accept the donation of$300.00 from Viviane Delima to be used for any needed service or material at the Police Department..Motion approved 5-0. From Elizabeth Wilson in the amount of L25,to the Fire Department for any needed equipment or service Elizabeth Wilson donated $25 to the Fire Department to thank them for assisting her. Chris Nobile made a MOTION,seconded by Phil DeCologero that the Board of Selectmen accept the donation of$25.00 from Elizabeth Wilson to be used for any needed service or equipment at the Fire Department.. Motion approved 5-0. From Richard Yee of two.frarried black and white local landscape photographs Rosemary Smedile gave a brief background of Richard Yee who donated seven framed black and white photographs. The photographs will be hung in the conference rooms at Town Hall. Rosemary Smedile made a MOTION, seconded by Richard Vaillancourt that the Board of Selectmen accept the donation of seven framed black and white local landscape photographs to be hung in the conference rooms at Town Hall. Motion approved 5-0. LICENSING COMMISSIONERS: Richard Vaillancourt made a MOTION, seconded by Phil DeCologero to open a meeting of the North Andover Licensing Commission. Motion approved 5-0. Board of Selectmen Minutes July 16, 2018 2 John Nioroge of Crossway Transit, LLC requests a Livery License at 30 Mass Ave. Licensing Chairman, Chris Nobile, moved the item to the next agenda as the application was not complete. Paul Gallant of Merrimack College requests a one day wine and malt license for a Hockey Association Beer Garden on August 4, 2018 from 1:OOPM-5:OOPM Regina Kean made a MOTION, seconded by Phil DeCologero that the Board of Selectmen, acting as Licensing Commissioners, approve the request of Paul Gallant of Merrimack College for a one day wine and malt license for a Hockey Association Beer Garden on August 4, 2018 from 1:OOPM- 5:OOPM. Motion approved 5-0. Requests from Deborah Ingalls of Butlers and Bars for events at Smolak Fars: One day all alcohol license for a party on July 27, 2018 from 5:OOPM-10:OOPM One day wine and malt license for a birthday party on July 29, 2018 from 3:0.OPM-9:OOPM One day all alcohol license for a wedding on August 4, 2018 from 4:OOPM-10:OOPM Phil DeCologero made a MOTION, seconded by Regina Kean, that the Board of Selectmen, acting as Licensing Commissioners, approve the one day license requests of"Deborah Ingalls for events at Smolak Farms on July 27, 2018, July 29, 2018 and August 4, 2018, as presented. Motion approved 5-0. Request for a change of manager at Walgreens of Massachusetts, LLC d/b/a Rite Aid Walgreens requested a change of manager from Pettece Palmese to Sarah Rinaldo. Ms. Rinaldo was present to answer any questions. Regina Kean made a MOTION, seconded by Phil DeCologero that the Board of Selectmen, acting as Licensing Commissioners, approve the change of managerrequest for Walgreens of Massachusetts LLC d1b/a Rite Aid. Motion approved 5-0. Request of Suni, Inc. d/b/a Town Mart for a wine and malt package store,license at 260 Winthrop Avenue. Attorney Jill Mann, legal counsel for Sunj, Inc. and Mr. Patel were presentto explain the request. Phil DeCologero made a MOTION,,seconded by,ReginaKeawn, that the Board of Selectmen, acting as Licensing Commissioners;approve the wine and malt package store license for Sunj, Inc. d/b/a Town Mart at 260 Winthrop Avenue. Motion approv6d 5-0. Richard Vaillancourt made a MOTION,seconded by Regina Kean to close a meeting of the North Andover Licensing Commission. Motion approved 5.0. CONSENT ITEMS: Request of Helen Pickard that the Board of Selectmen Proclaim North Andover recognize Indigenous People's Dov on the same day as Columbus Day, the second Monday in October Helen Pickard presented her request to proclaim the second Monday in October as Indigenous People's Day. Ms. Pickard believes that a,proclamation would honor and recognize the ancestry of our town and provide a more inclusive understanding, aligning with the school department's RAISE values. Ms. Pickard provided a copy of a statement from local clergy members. Kim Reardon, 62 Parker Street,,stated that the town has already acknowledged the significance of indigenous people,with the town seal, Lake Cochickewick and Weir Hill. Rosemary Buxton, 119 Old Farre Road, stated that in addition to symbols already used to acknowledge them, we can honor our ancestry by proclaiming Indigenous Peoples Day. Selectman DeCologero asked if there will be some kind of effort to educate, such as the program established with Race Amity Day. Ms. Pickard stated that this proclamation would start the conversation. Richard Vaillancourt made a MOTION, seconded by Phil DeCologero that the Board of Selectmen proclaim the second Monday in October as Indigenous People's Day and for a Proclamation to be read at the Board's meeting on September 24th. Motion approved 5-0. Waiver of building permit fee for renovations at the Kittredge School Included in the packet was a request from Stephen Foster, Facilities Director, to waive the permit fee for the renovations at the Kittredge School. Rosemary Smedile made a MOTION, seconded by Phil DeCologero that the Board of Selectmen waive the permit fee for the renovations at the Kittredge School. Motion approved 5-0. Board of Selectmen Minutes July 16, 2018 3 Vote to authorize Town Manager to approve requests to waive building permit fees for public protects and waive the right of first refusal for affordable housing units Chairman Kean suggested the Board allow the Town Manager to approve the waiver of building permits fees for public projects and the right of first refusal for affordable housing units in order to stream line the agenda and focus meeting on policy and discussion. The Town Manager would make the Board aware of whenever the authority was exercised. Selectman Vaillancourt would like building permit fees to remain on the agenda as a way of keeping the public informed. Selectwoman Smedile would like both to remain for transparency. Selectman DeCologero indicated the Board has given the Town Manager authority to approve other items. Selectman Nobile stated that transparency can be satisfied by putting them on the agenda under Town Manager's report. Rosemary Smedile made a MOTION, seconded by Richard Vaillancourt that both items remain on the agenda for Board of Selectmen approval. Motion approved 4-1. Chairwoman Kean opposed. The Board agreed that the Town Manager will provide them with a list of publit projects and the Board will preapprove permits for all of the upcoming projects at once so the Town is not waiting for permits to be approved before they can start the work. Town Manager Report (taken out of order) Town Manager, Andrew Maylor, introduced to the Board Jillian Brothers, his new part time executive assistant. Vote on whether to participate in the National Opioid Litigation Included in the packet was a letter the town received-asking it to join the National Opioid,Litigation. The Board discussed how the settlement would be determined and whether joining would preclude getting anything from the litigation filed by the Attorney General. The Town Manager indicated that any settlement would determine how the money could be spent.' Richard Vaillancourt made a MOTION, seconded by Phil DeCologero that the Board of Selectmen participate in the National Opioid Litigation. Appointments The appointment subcommittee recommend edthe following appointments: Ronn Faigen-Zoning Board of Appeals full member Michael Quinlan-Board of Registrars" Devon Smolak-Sustainability Committee David Brown-Stevens Estate Advisory Board Chris Nobile made a MOTION, seconded„by Richard Vaillancourt that the Board of Selectmen appoint Ronn Faigen as a,full member an the Zoning Board of Appeals, Michael Quinlan to Board of Registrars, Devon Smolak to the Sustainability Committee and David Brown to the Stevens Estate Advisory Board all for terms ending June 30, 2021. Motion approved 5-0. GOVERNMENTAL REPORTS Update from Zoning Board-Paul Koch Paul Koch gave the annual update of the Zoning Board of Appeals. Mr. Koch asked the Board to appoint the associate members as soon as possible so if someone is absent, they will not need a unanimous vote. Mr. Koch also asked about rewriting the Zoning Bylaw. Sidewalk Connectivity Plan-Johns Borgesi, Town Engineer and Monica Gregoire, Staff Planner Town Engineer, John Borgesf and Staff Planner, Monica Gregoire, presented the concept for a sidewalk connectivity plan. OLD BUSINESS: None NEW BUSINESS: None Board of Selectmen Minutes July 16, 2018 4 TOWN MANAGER'S REPORT: Introduction of Trinity Financial and Royal Crest Estates Study James Keefe, Eva Erlich and Aaron Holmes, Representatives from Trinity Financial, were present to explain the capital needs assessment they are doing for AIMCO/Royal Crest Estates. They will use the information to develop a master plan. GFOA Certificate of Achievement for Excellence in Financial Reporting Once again the town has received the Government Finance Officers Association Certificate of Achievement for Excellence in Financial Reporting. This is the sixth consecutive year the Town has received this award. Reports The Board was provided with the Police Department report, Fire Department report, Opioid Report, Building Department report and Job posting/vacancy log. Chairwoman Kean explained that they will be receiving from the other departments updates of progress to goals instead of the reports they have received in the past. The Town Manager explained that they have a database to tract goals but reports will most likely be quarterly as it is going to take a while to generate. The Town Manager gave a summary of the overall responses to the electricity su=rvey.. PUBLIC COMMENT (out of order) Stan Limpert asked for public comment to be put back at the beginning of the meeting and thanked the board for working toward data driven decision making. SELECTMAN'S UPDATES/COMMENTS Richard Vaillancourt reminded residents about all the activities that are going on in Town, including the Free Fitness Series, the Farmer's Market, Artisan Market, movie nights at Stevens Estate, and events at Stevens Coolidge House. Chris Nobile asked for a joint meeting to be set tip with the School Committee and Finance Committee. ADJOURNMENT: Chris Nobile made a MOTION, seconded by Phif DeCologero to adjourn the meeting at 9:30p.m. Motion approved 5-0. Laurie A. Burzlaff Executive Assistant Phil DeCologero, Clerk of the Board Documents used at meeting: June 18, 2018 minutes Franklin School donation letter Delima donation letter Wilson donation letter Yee donation memorandum Crossway Transit, LLC request Merrimack College request Smolak Farms requests Walgreens request Sunj, Inc. d/b/a Town Mart request Wavier of permit fee request National Opioid Litigation materials Appointment memorandum Sidewalk Connectivity Plan presentation GFOA Certificate of Achievement Departmental Reports AGENDA COVER MEMORANDUM To: Board of Selectmen Tru: Andrew W. Maylor From: Laurie Burzla , Executive Assistant Date: August 2,2018 Re: Donation The Board is being asked to accept a donation from Wheelabrator in the amount of$10,000 to be used to pay the annual invoice for the Trauma Intervention Program. ! ORT, [ COVER Laurie Burzlaff<Iburzlaff@northandoverma.gov> Fwd: Wheelabrator North Andover Sponsorship of Trauma Intervention Program (TIP) 1 message Andrew Maylor<amaylor@northandoverma.gov> Fri, Jul 13, 2018 at 10:58 AM To: Laurie Burzlaff<Iurzlaff@northandoverma.gov> For the next agenda. ----------Forwarded message--------- From:John Farese<jfaree finer y.co > Date: Fri, Jul 13, 2018, 9:16 AM Subject:Wheelabrator North Andover Sponsorship of Trauma Intervention Program(TIP) To: amaylor@northandoverma.gov<amaylor ortanoverma. ov> Cc: Gary Collette < collette wtienergy.com> Mr. Maylor In recognition of the fine services provided by the North Andover Police and Fire Departments,Wheelabrator would like to provide a$10,000 donation to fund the services TIP provides to our community as referenced within the attached invoice. Best regards, John Farese CONFIDENTIALITY NOTICE:This message originates from Wheelabrator Technologies Inc.This message and any attachments are solely for the use of the intended recipients. They may contain privileged and/or confidential information or other information protected from disclosure. If you are not an intended recipient, you are hereby notified that you received this email in error and that any review, dissemination, distribution or copying of this email and any attachment is strictly prohibited. If you have received this email in error, please contact the sender and delete the message and any attachment from your system. 2018 Trauma Intervention Invoice TIP.pdf 182K T p Trauma Intervention Program of Merrimack Valley, Inc. .,CitiZell.1' hP��)lll,� citiz,ells ill cri.s is•. BOARD OF DIRECTORS July 2,2018 Director Andrew Maylor,Town Manager Kristin Kowalski,MS,CLS 120 Main Street Chairperson North Andover MA 01845 Diane Lovallo RN,MSN,MBA , Crisis Team Manager Wendy Delaney,Esq. Dear Andrew, Rev.John Delaney Thank you for your past support of the Trauma Intervention Program in the Chief Paul Gallagher Merrimack Valley, Inc. (TIP). TIP works hand in hand with your police and fire Chief Charles Gray departments providing on scene victim assistance to town residents. Barbara Grondine Chief Patrick Keefe Chief William McCarthy Print and T.V. media, along with North Andover residents continue to see the Chief Michael Mansfield value in our volunteer efforts as the police and fire departments call TIP Beth P Tim She RN by volunteers to assist adults and children in need of emotional and practical support. Chief Tim Sheehy P Pp Chief Joe Solomon TIP is entering its 26d' year of service and has provided direct on scene assistance to well over 27,000 children and adults in our community. TIP VOLUNTEERS Feedback from emergency first responders and victim survivors continues to be very positive. Most notably the responders appreciate being "freed up" from the Lisa Apovian emotional needs of their clients so they can tend to their on scene job Shelagh Boudreau responsibilities knowing the traumatized children and adults in the community are Susan Comeau Beth Corcoran being cared for. Family members especially appreciate not being left alone in a Wendy Delaney crisis situation and TIP's presence makes the "system"look good. Sally Gaffney Kathy Grant Sue Grenier Enclosed the annual invoice for $10,000 for TIP services for the Town of North Joyce Hashem Andover. If I may be of further assistance, please do not hesitate to contact me. Karen Held Kristin Kowalski Pam LaBarre Jay Lafond Kathy Larocque Sincerely, Ruth Ann LeHane 'l Karina Marcotty Y r �Y1 �. C k-k--I C� L Alice McLeod Susan Ros Kristin Kowalski MS t,ti�' �� Patricia Sheehan ' �� Keri Stella Director Ellen Townson Susan Wartman CC: Chief Charles Gray f Chief William McCarthy J"� Ck Scott Emerson 21 Central Street#21 Andover,NIA 0 18 10 (978)475-TIPS(8477) Trauma Intervention Program T P of Merrimack Valley, Inc. "Citizens helping citizens in crisis" INVOICE DATE INVOICE# 7/2/2018 8 BILL TO: BILL TO: Wheelabrator Technologies Susan Hamel—Sr Accounts Payable Clerk, SSC 285 Holt Road North Andover, MA 01845 DESCRIPTION AMOUNT TIP OF MERRIMACK VALLEY USER AGENCY FEE $10,000.00 ON BEHALF OF THE TOWN OF NORTH ANDOVER Send to: TRAUMA INTERVENTION PROGRAM OF MERRIMACK VALLEY, INC. 21 Central Street#21 TOTAL $10,000.00 Andover, MA 01810 21 Central Street#21 Andover,MA 01810 A (978)475-TIPS(8477) NORTH ANDOVER YOUTH & RECREATION SERVICES 33 JOHNSON STREET NORTH ANDOVER MASS. 01845 (978) 682-9000 To: Laurie Burzlaff, Town Manager's Qfficew..... From: Rick Gorman, NAYRS Dir ctor w Date: 7/20/18 Re: Donation from McDonalds/ Lietz Family. Hi Laurie Please find attached a copy of check from The Lietz family in the amount of$2,000.00. The check was deposited but need B.O.S. to accept the donation at their next meeting. If you have any questions please let me know. C &J LLC F- Bank 10611 GENERAL ACCOUNT America's Most Convenient Banken MCDONALD'S RESTAURANT 53-7054/2113fA@a :onqM L P.O.BOX 907 ANDOVER,MA 01810 714 Q-11 A- PAY TO THE ORDER OF ov r *'2,000.00 Two Thousand and 00/100no[ MEMO NJTHOFUM SIGMTURE 111010611ii' 1: 21 1370545i: 8 247954436ii' t �Q� TOWN OF NORTH ANDOVER OFFICE OF TOWN CLERK 120 MAIN STREET NORTH ANDOVER,MASSACHUSETTS 01845 tkORTH 0 Joyce A.Bradshaw,C 10 Telephone(978)688-9501 Town Clerk FAX(978)688-9557 Ss S MEMORANDUM TO: Chris Nobile, Chairman, Licensing Commission Members of the Board of Selectmen Andrew Maylor, Town Manager FROM: Suzanne M. Pelich, Asst. Town Clerk DATE: August 13, 2018 SUBJECT: Livery License Application Attached please find the application for a Livery License from John Njoroge on behalf of Crossway Transit LLC. The property is located at 30 Massachusetts Ave. Suite 409. Included are favorable recommendations from the Police Department, Fire Department and the Building Inspector. Please do not hesitate to contact me if you have any questions or concerns. Thank you. i r TOWN OF NORTH ANDOVER �. BOARD OF SELECTMEN GENERAL APPLICATION This is a general application for a license that the Board of Selectmen may grant. All license I applications to the North Andover Board of Selectmen must be accompanied by the following h information. I Indicate if license is: new o tr 1 B 6 f t r ❑ change of dba❑ Other: List type of license(s)applying for: ❑ U Common Victualler FlP ackage Store All Alcohol Class I N o.ofvdicles for display.— Ream=All AlcobolElP ackage Store Wine&Malt Fla.II Na ofvetucles fer display:_ Restaurant Wine&Malt EjFortune Teller ❑ Club All Alcohol OVeliicle for Hte(raxi No of Velrlcles: Annnal Entertainment Sunday Entertainment Electronic Games-list below: 1 ❑ jukebox ❑ Billiard Table No.of tables: Business Name(legal):IZDSS W�-U 1 RANSi 1 dba: Please attach copy of business certificate if applying as dba or individual. If business is a corporation or LLC, please attach: 1. Certificate of Good Standing from the Secretary of State's Office. 2. Corporate Vote authorizing business at the location. Address of licensed premises Cmclude zip code):__� M ASS. k\/C—: Sic AM mailing address (if different than above address): Name of individual/applicant authorized to apply for license Z56hn Vel t d C7aGe i Business tel.no, of applicant: 3000 Business email: &-dry in C re)99W" Po,-L , F.E.I.N:(F.I.N.). ,)--532 x-42 Please check one of the following:❑own premises [9 ease premises❑property under P&S Name and address of,property owner if different from license holder: CiL Ur K«-, ame acc. If applicable,please attach copy of lease and/or Purchase and Sales Agreement Do you currently hold a similar license? What type?_ Have you previously applied for a license? (Yes)❑ (No)rm Have you ever had a license revoked? (Yes)❑ (No) If yes,please indicate why: I i f i Ifthere is a building or structure associated with the license,please submit the following (preferably on 81/2 x 11"paper-no larger than 8 1/2 x 14"): 1.Floor plan(include seating area), and 2.Site plan indicating parking areas and access to town ways. If applying for a Class I or Class II license, please submit a plot plan that shows: I.The number of the vehicles on display 2.The exact location of the vehicles 3.Customer parking 4.Office area Proposed hou of operation: Monday "fan—S�Q+K Thursday CLM Tuesday —SS riday a.- — Wednesday cta-t — SRA Saturday Sunday (Specify liquor sale hours if different than regular establishment hours): Has the applicant operated a similar business? (If applicable) 1JO Name of Business: Address: ] Federal Tax No.(If applicable): kJ l A 1 certify that the North Andover Police Department may run a criminal records check for any prior offenses and that this information may be transmitted to the Local Licensing Authority at their request. Date: 2 Signature. I certify under the penal. of perjury that I,to the best of my knowledge and belief, have filed all state tax returns and paid all state and local taxes required by law. f r % Date. ! 118' signature: -�----� I certify that I have read:::; the conditions included with this license and agree to comply with any further stipulations that the Licensing Authority may from time to time approve. I also hereby authorize the Licensing Authority or their agent to conduct whatever investigation or inquiry is necessary to verify the information contained in;his application. f � . Date-, S a'1[r r Signature• . Please contact the Town Clerks Office at(978)688-9501 if you have any questions regarding this application form. RrAewedand amended:2011 2 Mass.Corporations,external master page MA 01845 USA The name and business address of the person(s) authorized to execute, acknowledge, deliver, and record any recordable instrument purporting to affect an interest in real property: Title individual name Address REAL PROPERTY JOHN NJOROGE 30 MASS AVE, SUITE 409 NORTH ANDOVER, MA 01845 USA -- -- Confidential - Merger - Consent Data Allowed Manufacturing View filings for this business entity: ALL FILINGS Annual Report ,, Annual Report - Professional Articles of Entity Conversion Certificate of Amendment View filings Comments or notes associated with this business entity: New search -ittp://corp.sec.state.ma.us/CorpWebiCorpsearch/CorpSummary.aspx?FEIN=001324842&SEARCH TYPE=1 2/2 ro//i%/�fl'f°'�'/%/ /i!%ai%jri��e�if%/I/ °�(�'%// l/�� "///lj��rl'147 ?�i'ifl%"1✓ i,,, ., ,� a;% i, r,i,i z:/ ,;/ ,r,,,. ;: ".. �%, I f/.'//�% 'r/✓%tri%r.� ,� 1�//,�i/ /, / l ',r' r - l' �/ ° p F^'r .r / p//f I � ,..:, //vl�// G/ �l / r ✓� / J� ,,,, /,a l/ rr /l/ r4� J �� r r �, �,/J�el/�i ,,,o„ ,-�i�%�ir,,,,,, ,�,n,,,, /l ,,,,., ;,��y��i/�i,,�j/ir✓�//,,, %j/�O� ,ai��1,r� r �r,1 I /� ///r0,,, / , ,�,/i ,,� ,,,�u/i/ � ,," ,. 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G�i„ ra, r / it r /c.,/ i, ./ / /ii :.. � a / r% r ✓ / � ., r //f / r.r �i 1. ,..,,, r ,.... �.. r �,.. ,,. r� ,/ ,� l'. >�' ✓,..,� , .� /...>'r/. r r/,; r „ .,„/;, ✓.,.r� „a,. �ref(1.. ,r, //„„- o, .//,� r n ✓,G � ,. / i��,,.��/.:�/r/,e, r/i .,,,, /�i, ,,a r��b,,,f�/�� i/ '®l a9fi 'f >' �� f r/ff,j i,:;,, �l i/ I, / � ,��,/i�1�•�,"1/l�i� /„ ''l�/ i1r///i/��f' �/�/ /o ( � v � �� s r/� /ii f/ r '%ii/i�'✓ r �i� s i / a f ; r' Am�ssDOT CERTIFICATE F REGIST TON RMV Division R°g °rs°�awmcr� M.G.L.Chapter 90 Section 246 lakes a crime to alterth Certific to PLATE TYPE REGISTRATION NUMBER REGISTRATION TYPE EFFECTIVE DATE _ MO YEAR ION NUMBER CON T70344 COMMERCIAL 04/30/ ��. 1 18 01812075110135 MFRS MODEL YEAR MAKE MODEL ` BODY STYLElTYPE COLOR IF VEHICLE TOTAL REGISTERED Not valid wit ut official CARRYING W FOR A 2010 FORD CUTVANi VAN WHIT signatl�re egistrar PASSENGERS COMMERCIAL VEHICLE OR HIRE TRAILER. VEHICLE IDENTIFICATION NUMBER INSURANCE COMPANY LE NUMBER REGISTRAR MAXIMUM 1FDFE4FSXADA82241 COMMERCE INSURANCE PAAs�sENG� t THAT CAN BE RESIDENTIAL ADDRESS(IF DIFFERENT) (/SIJ_-('/• SEATED. 015000 NAME(S)OF OWNER(S)AND MAILING ADDRESS FEE CROSSWAY TRANSIT LLC ISTRATION 300.00 30 MASS AVENUE E 75.00 S TE 409 AL PLATES 0.00 N ANDOVER, MA 01845 TAX 875.00 TOTAL 1250.00 MASSACHUSETTS DEPARTMENT OFRAN PORTATION REGISTRY OF MOTOR.VEHICL DIV SION The records 4f the RMV database constitute the offidal statu the veh le registration. � t SPECIAL MESSAGE CHANGE ADDRESS IF THIS VEHICLE IS NEWLY ACQUIRED, IT MUST BE INSPECTED WIT14IN SEVEN (7) DAYS STREET OF REGISTRATION. I CITY,ST E LP CODE Important Informati n fo Vehicle Own6r Every person operating a motor vehicle shall have the Certifii- Ret rn the registration plates to the RD IV immediately if: cate of Registration for the motor vehicle and for the trailer,if y;ani his/her license to operate,upon his/herpersun orin -Th vel�loe-trs been-;d rjuni.ed� .dthe i egistrtiv-n��roi- — the vehicle,in some easily accessible place. g ng to be transferred to another v hicle.Keep a copy of the Bill o ale,Title, and com Ie d Reassig ent of�tle ryour By taw,you must report any charge of address to the RMV with!. re ords to document'he nsfer. 30 days in writing.Address changes can be made on the RMV Yo move to another tat and your gister the vehicle in that state. website:www.massrmv.com or by mail to:RMV,P.O.Box 55889 Boston,MA 02205-5889.Once you have reported the address Th insurance policy is no renewed is cancelled and there is change to the RMV,please write corrected address in box no plan to obtain a ne p licy. provided above. 1 Transferring Your Plates: Massachusetts law (M.G.L. Chapter 90, Sectior allom s you to transfer vaGI r anon p tes from this vehicle to a newly acquired new or used motor vehicle or trailer while yo obtain insurance and a new rel ration.All of the following must be met: 1.You are at least 18 years ofl age and you own the motor vehicl or trail r identified onthis e ' tration Ce ficate,2.You transfer ownership of this vehicle to another person or permanently lose posses n of It such as through rep s fon,etc.); .The newly acquired vehicle is of the same vehicle type(passenger vehicle to passer r vehic e,trailer to traller,a c.); a same r tion type (passenger to passenger,commercialito commercial); and has the same tuberwheels;and,4.The and b er properly complete the Assignment of the Certificate of Title(for the newly acquit use vehicle)or Certifica e o Origin(if a new"vehicle). If all of the above are met,you may operate the newly acquired vehicle with a tran 'erred plates up to :0 m of the th calendar day following the date of transfer(or loss of possession). The day of transfer or loss is y 11. uring those 7 days, u ust cant'th Bill of Sale (or the dealer's Purchase Contract)for the newly acquired vehicle and this Regij tion rtificate when oper tin the vehicle See FAQs About rhe Seven-Day Registration Transfer Law on the RMV'S website at www.mass com No Insurance Card Required:Massachusetts's law does not require an ins nce c ird. The law,M.G.L. a r 90, Sectl n 34A and Chapter 175, Section 113A requires t,e vehicle's owner to maintain a co pulso motor vehicle liabil( ( urance poi cY or bond for bodily intury coverage and property damage insurance. If an insurer is identified on face f this Registration Ceti r te, it is re ulred by law to electronically notify the RMV(Reg)str�of Motor vehicles)if coverage laps .The v hicle owner is then o eci by the V to obtain new insurance within 10 days or the regis"tion will be revoked.Bonds are fl d with he State Treasurer��ffi Be first in line by going c lin at www. a rmv. om Schedule a Road Test Request a Duplic a Titi Renew Your Driver's LicenseRequest a Duplic a Re istration NE TO VIS AN RMV OFFICE. Renew Your Registration Change Your Ad ess SA TIM Pay Citations/Court Nearingee Cancel My Platel egistr tion Com tete Your Replace Your Driver's License Order a Special to Appiica ion Online! VISIT OUR WEBSITE FOR A FULL IST F AVAILABLE SACTI NS SPI3061T 07/2014 ► ssE ,►�� CERTIFICATE F I 4. as9�I M, M.` .L. Chapter 90 Section 24 mak it a crime to REG I S a to this Cert 1`aalte RMV Division PLATE TYPE REGISTRATION NUMBER REGISTRATION TYPE EFFECTIVE DATE EXPIRES ON YEARINSACTION NUMBER CON T39782 CQMMERCIAL 04/27) LAST DAY OF *► 18 811767630104 MFRS MODEL YEAR I MAKEMOD l BODY STYLEMPE LOR IF VEHICLE TOTAL REGISTERED N t v I Without&11481 CARRYING WEIGHT FOR A 2010 FORD ECONOL VAN ITE ign re of Regist r PASSENGERS COMMERCIAL VEHICLE FOR HIRE: OR TRAILER. VEHICLE IDENTIFICATION NUMBER I INSURANCE COMPANY TLF NUIR RECaIST R MAXIMUM NUMBER OF 1FTNS2EW8ADA05305 COMMERCE INSURANCE PASSENGERS A t RESIDENTIAL ADDRESS QTHAT CAN BE F DIFFERENT) L, /JIY_. ' SEATED. 9000 NAMES)OF OWNER(S)AND MAILING ADDRESS FEES REGIST TION 180.00 CROSSWAY TRANSIT LLC TITLE 75.00 30 MASS AVENUE SPECIAL PLATES 0.00 STE 409 N ANDOVER, MA 01845 SALES 749.69 T TAL 1,004.69 MASSACHUSETTS DEPARTMENT OF T T SP RTATION REGISTRY OF MOTOR VEHICLESV1SI N The records of the RMVdatabase constitute the official statf the ehicle registration. .. SPECIAL MESSAGE- — ._ — --_ I .- --•C 'GE OF ADDRESS - IIt I IF THIS VEHICLE IS NEWLY ACQUIRED IT STR EET ADDRESS MUST BE INSPECTED WITHIN SEVEN (7S DAYS OF REGISTRATION. k CI ,STATE.ZIP CODE f Important Informal rn fir Vehicle 0++s • Every person operating a I}notor vehicle shall have the R turn the registration tat to the RM immediately if: Certificate of Registration fort the motor vehicle and for the trailer, if any, and his/her liclense to operate, upon his/her - he vehicle has bee s or junked nd the registration is not going to person or in the vehicle,in some easily accessible place. a transferred to ano er ehicle.Kee a copy of the Bill of Sale, Title, nd completed Rees gn ent of T/tl for your records to document the • By law, you must report any hange of address to the RMV ansfer. within 30 days in writing. Address changes can be made on the RMV website:www.mass.gov/rmv or by mail to:RMV,P.O. - ou move to another tat nd you reg ster the vehicle in that state. Box 55889, Boston, MA 02205-5889. Once you have reported _ he insurance policy i5 n renewed o is cancelled and there is no plan the address change to the RMV, please write corrected obtain a new policy. address in box provided above. I Transferring Your Plates: Massachusetts law (G.L. Chapter 90, Se on 2) flows you to transfer at registrati n plates from this vehicle to a newly acquired new or used motor vehicle or trailer while you obta insure ce and a new registratlo Al the folic ing must be met: 1.You are at least 18 years of age and you own the motor vehicle or iter id ntified on this Regisfr''ati Certificate.2.You transfer ownership of this vehicle to another person or permanently lose possession of it(suc s thro gh repossession, etc); The newly acquired vehicle is of the same — vehicle type (passenger-vehicle to-passenger vehicle,trailer to trail , etc.-)--the-same-registratlAn pe (passen et to-passenge?-commerdial-to commercial);and has the same number of wheels;and,4.The properly complete th Assignmen of the Certificate of Title(for the newly acquired"used"vehicle)or Certificate of Origin(if a"new"vehl I .If all a above are met,you m operate th newly acquired vehicle with the transferred plates up to 5:00 pm of the 7th calendar day following t date transfer(or loss of ' s ssion).The day of transfer or loss is day#1. During that 7 days,you must carry the Bill of Sale(or the dealer's Pu as, C Contract)for the newly�cq (red vehicle and this Registration Card when operating the vehicle.See FAM." the Seven-Day Registration nsfer Law on the RMV's w bs! at www.rn I ssrmv.com. No Insurance Car Required: Massachusetts'law does dot require Insu ce card.The law, Jinu' riice . . Chapter 9 ,Section 34A and Chapter 175, Section 113A requires the vehiclef s owner to maintain a compulsory otor ve icle insurance polir and for bo fly injury coverage and property damage insurance.If an insurer is(identified on the face of this Regist 'on Ce ificate,itis requiredla to electron ally notify the RMV(Registry of Motor Vehicles)if coverage lapses.The vehicle owner is then notifie y the MV to obtain new within 1 days or the registration will be revoked.Bonds are filed with the tate Treasurer's Office. BE FIRST IN LINE BY GOING 0NL NE AT WWW M SSRM .COM Schedule a Road Test Request a Duplica Title N E TO VI IT AN'.RMV'OFFICE? Renew Your Driver's Licens Request a Duplica Regi tration S VE TIME Renew Your Registration Change Your Add ss CO plete Your Pay CitationslCourt Hearing Fee Cancel My Plate/R istra on Replace Your Driver's LicenseOrder a Special PI a App{I anon Online! VISIT OUR WEBSITE FOR A FULL ST O AVAILABLE TRANS CTIONS SPI3061T 04/15 TOWN OF NORTH ANDOVER PRIVATE LIVERY & TAXICAB LICENSE APPLICATION (See Licensing Commission Policies) DATE OF APPLICATION: I I I;?, NEW: RENEWAL: TYPE OF APPLICATION: TAXI: PRIVATE LIVERY: BUSINESS NAME: TAX ID#: 72-q32!J4L ADDRESS: 3c) MkSS c, NA- t,-n TELEPHONE BUSINESS RESIDENCE: TELEPHONE HOME: ( ) DATE OF BIRTH: NUMBER OF VEHICLES TO BE LICENSED: LOCATION(S)WHERE VEHICLES TO BE GARAGED: 30 MSS kyC. FEE: $250.00 PER VEHICLE FOR HIRE PER YEAR: EXPIRES DECEMBER 31sT FEE: $100.00 PER VEHICLE FOR HIRE DRIVER EXPIRES ON DATE OF ORIGINAL APPLICATION. DESCRIPTION OF VEHICLES Make Model Year VIN# Owner Reg.# _ T3 2 ;g& cdivPoj /oLo(n {�F'pFG L4-,F'Sx pt A 8;2a 4 eos5"Pxy 7gA,NS f /7-_7 03 4�- 3 / 4 5 6 7 8 9 10 I SWEAR THAT THE INFORMATION GIVEN IS COMPLETE AND ACCURATE (Si of Indi dual) Corporation=Signature of resident Co oration - Signa a of Treasurer Corporation - Signature of Director Corporati Signature of Director 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. i SIGNATURE OF INDIVIDUAL . CORP RATE OFFICER CORPORATE NAME-MANDATORY MANDATORY,IF APPLICABLE SOCIAL SECURITY NUMBER(VOLUNTARY): a— S+3-2(�i-v2 OR FEDERAL IDENTIFICATION NUMBER APPROVAL OF A CONTRACT OR OTHER AGREMENT WILL NOT BE GRANTED 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 MEET TAX FILING OR TAX PAYMENT OBLIGATIONS. PROVIDERS WHO FAIL TO CORRECT THEIR NON- FILING OR DELIQUENCY WILL NOT HAVE A CONTRACT OR OTHER AGREEMENT ISSUED.RENEWED OR EXTENDED. THIS REQUEST IS MADE UNDER THE AUTHORITY OF MASSACHUSETTS GENERAL LAWS, 2C §49A. s Ti SITE LEGEND —ONE— OVERNEAD ELEC.SERV, U M R —EP 2-4`C(PVCt FRfMARY DUCT HARYI F- _ —ES— S-44C(PVC)SECONDARY DUCT BANK —F -2:C(PvCI FIRE SERVICE _ —T 2-4'C(WC)TELEPHONE SERV. M56 MAIN 5WITCHBOAD PANEL - - SAe SA-SITE LIGnT 40OW N.P.G. 208V �C Selo Se-SITE LIGHT 250v1 H.P.5. 20&V 5C0 SC-BOLL ARC]Ow I+.P.S. 120V SNA / I f1r Y' /i I -XI / w "AT �5q I au."t SCLfi: zoA T. SEE D.G.E-3 taCR TEL.En TRACE SEE DWG.E PROPOSED OFFICE BUILDING ES 1"C-3�IO VIA P.0 20a-2F �r L - VIA I, VIA T c IA SAC a T. sc P 1 SI E L I SIGN VIa21T.C. EQ --__._ \- t.\ _— _— Clll, e UTILITY ROLE /An NGw LIa TGf, fanEL MASTER DCx - "OF bQF MASS. AVE. S VEST } 7 '.1. ENTRAINLE DETAIL -� - a EI ITLL t �� ---- i ----- L Cil UTO- TELL. OFFICE 117 U) yU� b OFFIGE Ilt+ ii; � yid �d fl❑ M o t 1 I L I E'xistine Conditions Drawings:3'.24114 s� onwe: ares Project tisane: 30 Massachusens Avenue ca sus x n ted, aR Joel David Silverwatch Architect AIA �.�.� Prepared For: RichLL7 Prupertirs _.. s.cx ' 30u Av xeus Architeaurf'Fhgi ng°Design'Lend Plarming sear I s.-t,.m. Project Address. :nate pry atassac-heseur 224 Win St(M unit 38 Salem,N4 CIM .� n� szs.i< Sheet Title: tee+. •max„�.ro.� rrti eet�o: sacx-u i Fourth f'Ioor Plan t NQRTH ANDOVER ••.Community Partnership--- operations Division Lieutenant Daniel P.Lonen TO: Suzanne Pelich FROM: Lieutenant Daniel P. Lanen :o—� RE: Crossway Transit DATE: June 20, 2018 Please be advised that the following attached request for a Private Livery and Taxicab License has been reviewed. The Police Department has no issues with the license application as filed. A background check of managers:Daniel Kangethe, Shannon Njoroge,John Njoroge and Kangeth Florence Wania has not uncovered any adverse information to affect this application. E. 1475 Osgood Street,North Andover,Massachusetts 01845 Telephone;978.683-3168 Fax:978-881-1172 h U� m le mim 1, NORTH ANDOVER K VA .. / ` ...Community Partnership--- Operations Division Lieutenant Daniel P.Lanen TO: Suzanne Pelich FROM: Lieutenant Daniel P. Lanen RE: Crossway Transit DATE: June 20,2018 Please be advised a background check has been performed for Sarah Campos-Belieny and Simon Gitau for Livery and Taxicab operators. The check has not uncovered any adverse information to affect this application. 1475 Osgood street,North Andover,Massachusetts 01845 Telephone:976-663-3166 Fay 978-661-1172 5/24/2018 Town of North Andover Mail-Re:Scan from Clerk's Office NO ° 0VER Suzanne Pelich <spelich@northandoverma.gov> Re: Scan from Clerk's Office 1 message Robert Bonenfant<rbonenfant@northandoverma.gov> Thu, May 24, 2018 at 7:17 AM To: Suzanne Pelich <spelich@northandoverma.gov> The Fire Department has no issues with this application. On Mon, May 21, 2018 at 1:33 PM, Suzanne Pelich <selic anvr a. v>wrote: Good Afternoon, Attached please find an application for a livery license from John Njoroge on behalf of Crossway Transit located at 30 Massachusetts Ave. If you could please send me your recommendations. Thank you, Suzanne ----------Forwarded message---------- From: <spicors o handover a. ov> Date: Mon, May 21, 2018 at 1:29 PM Subject: Scan from Clerk's Office To: Suzanne<spelic ohover v> I This E-mail was sent from "Clerks-Ricoh-SP-5210SR"(Aficio SP 5210SR). Scan Date:05.21.2018 13:29:45 (-0400) Queries to: spiceworks@northandoverma.gov i i Suzanne M. Pelich Assistant Town Clerk 120 Main Street North Andover, MA 01845 Phone:(978)688-9501 Fax:(978)688-9557 Email spelich@northandoverma.gov Web www.northandoverma.gov https://mail.google.com(maiVu/0/?ui=2&ik=00f5O782ad&jsver-FPvd7uxXULs.en.&cbl=gmaiB fe_180508.13_p10&view=pt&search=inbox&th=16391de873323b2d&siml=16391de873323b2d&mb=1 1 5/23/2018 Town of North Andover Mail-Re:Scan from Clerk's Office No DR k4amchu , � Suzanne Pelich<spelich@northandoverma.gov> Re: Scan from Clerk's Office 1 message Donald Belanger<dbelanger@northandoverma.gov> Wed, May 23, 2018 at 3:00 PM To: Suzanne Pelich <spelich@northandoverma.gov> Cc: Robert Bonenfant<rbonenfant@northandoverma.gov>, Daniel Lanen<dlanen@napd.us>, Suzanne Egan<segan@northandoverma.gov> Suzanne, The Building Department has no issues with the application for a Livery At 30 Massachusetts Ave. in a GB Zoning District. A Certificate of Occupancy and or Building Permit (for tenant fit-up pending on extent of renovation) are required prior to occupying/operating new Business. Please contact the Building Department at 978-688-9545. Please answer the following question: Thank you, Donald Belanger On Mon, May 21, 2018 at 1:33 PM, Suzanne Pelich <spelich northandover . ov>wrote: Good Afternoon, Attached please find an application for a livery license from John Njoroge on behalf of Crossway Transit located at 30 Massachusetts Ave. If you could please send me your recommendations. Thank you, Suzanne ----------Forwarded message---------- From: <sicewors no handover a.gov> Date: Mon, May 21, 2018 at 1:29 PM Subject: Scan from Clerk's Office To: Suzanne<spelich northandover . ov> This E-mail was sent from "Clerks-Ricoh-SP-5210SR" (Aficio SP 5210SR). Scan Date: 05.21.2018 13:29:45 (-0400) Queries to:spiceworks@northandoverma.gov Suzanne M. Pelich Assistant Town Clerk 120 Main Street https://mail.google.com/maiVu/0/?ui=2&ik=00f5O782ad&jsver-FPvd7uxXULs.en.&cbl=gmail_fe_180508.13_p10&view=pt&search=inbox&th=1638e6O28486fc6g&siml=1638e6O28486fc6g&mb=1 1/: 7/9/2018 THE COMMONWEALTH OF MASSACHUSETTS TOWN OF NORTH ANDOVER OFFICE OF THE TOWN CLERK 120 MAIN STREET NORTH ANDOVER, MA 01845 Q, Q Certificate#: 2018-36077 This is an e-permit.To learn more,scan this barcode or visit.viewpointcloud.comtxrecords/ k Q IN CONFORMITY WITH THE PROVISIONS OF CHAPTER 110 SECTION 5 OF M.G.L., AS AMENDED, THE UNDERSIGNED HEREBY DECLARE(S) THAT A BUSINESS UNDER THE TITLE OF: Crossway Transit IS CONDUCTED AT 30 Mass ave STE 409 North Andover ma Issued to: John Njoroge Business Type: L.L.C. Additional Applicants: Sat Jul 09 2022 16:29:27 GMT+0000(UTC). Business Certificate Application Expiration Joyce A.Bradshaw,Town Clerk �® DATE IMMIDD/Y ACC> YYY ) ` CERTIFICATE OF LIABILITY INSURANCE o5/21/2o1s 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(les)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 CONTACT NA annie lukas T EDMUND GARRITY&CO INC (HONE 61 354-4640 FAX No: E-MAIL ADDRESS: D • annie arrl -insurance.com 545 CONCORD AVENUE INSURER(S)AFFORDING COVERAGE NAIC# CAMBRIDGE MA 02138 INSURERA: AIM MUTUAL INS CO 33758 INSURED INSURER 8: CROSSWAY HOME CARE LLC INSURERC: INSURER D: 30 MASSACHUSETTS AVE INSURER E: N ANDOVER MA 01845 INSURER F: COVERAGES CERTIFICATE NUMBER: 271386 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MMI MI W M /Y7 COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ TO RENT CLAIMS-MADE 7 OCCUR PRMAGE MI E Ea occu D nce $ MED EXP(Any oneperson) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY❑ PRO- F7 LOC PRODUCTS-COMP/OP AGG $ JECT I OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ a accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED N/A BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $HIREDAUT05 H AUTOS (Per accident) $ UMBRELLALIHBOCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE N/A AGGREGATE $ DED FFRETENTION$ $ WORKERS COMPENSATION X AND EMPLOYERS'LIABILITY STATUTE ERH YIN A OF IC RIMEMBEREXCLU EDD? E.L.EACH ACCIDENT $ 1,000,000 "" E NIA WA NIA AWC40070364432018A 04/26/2018 04/26/2019 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,desaitle under DESCRIPTION OF CPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 N/A DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached H more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.govilwd/workers-compensationAnvestigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Element Care ACCORDANCE WITH THE POLICY PROVISIONS. 37 Friend St AUTTHHORIZEDREPRESENTATIVE Lynn MA 01902 Daniel M.Cr y,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD COMMERCIAL LEASE AGREEMENT In consideration of the covenants herein contained, DISCOVERY BAY HOLDINGS LLC, hereinafter the LESSOR, which expression shall include successors and assigns where the context so admits, does hereby lease to Crossway Homecare LLC, hereinafter the LESSEE, which expression shall include successors and assigns where the context so admits, and the LESSEE hereby leases the following described premises, hereinafter called the "Leased Premises": Suite 409, comprising approximately 1,300 square feet, more or less, in the building known and numbered as 30 Massachusetts Avenue (the Premises), located at 30 Massachusetts Avenue, North Andover, Massachusetts 01845. TO HAVE AND HOLD the leased premises for a term beginning January 1, 2018 and terminating on December 31, 2020. LESSOR AND LESSEE now covenant and agree that the following terms and conditions shall govern this lease during the term hereof and for such further time as LESSEE shall hold the leased premises. LRENT. LESSEE shall pay to LESSOR a total annual ]case payment, for the first year, of Twenty- Two Thousand Eight Hundred Dollars ($22,800.00) payable in advance, in installments of$1,900.00 per month on the first day of each month. LESSEE shall pay to LESSOR a total annual lease payment, for the second year, of Twenty-Three Thousand Four Hundred Dollars ($23,400.00) payable in advance, in installments of 51,950.00 per month on the first day of each month. LESSEE shall pay to LESSOR a total annual lease payment, for the third year, of Twenty-Four Thousand Dollars($24,000.00)payable in advance,in installments of 52,000.00 per month on the first day of each month. Said payments shall be made as follows: To The Order of Discovery Bay Holdings LLC, at the LESSOR's on-site office or via mail to 30 Massachusetts Avenue, North Andover, Massachusetts 01845,or as may be amended in writing by the LESSOR. 2. LATE PAYMENTS. Any rent payment not received by the LESSOR on or before the fifth day of the month for which it is due shall incur a late payment penalty of$25.00 plus 5% of the monthly payment outstanding. 3. USE OF PREMISES. LESSEE shall use the leased premises solely for the purpose of operating a professional office and uses appurtenant thereto. The Leased Premises may be used for other purposes only with the express written consent of the LESSOR which consent shall not be unreasonably withheld or delayed. LESSEE shall notify the LESSOR of any anticipated extended absence from the Leased Premises not later than the first day of the extended absence. 4. UTILITIES. LESSOR shall be responsible for providing electricity, gas, heating,trash disposal, and common area janitorial services, and for payment of all charges and costs incurred for all such utilities and services, LESSEE shall be responsible for janitorial services within the Leased Premises, internet and telephone service, all of which have been explained fully in advance by LESSOR to LESSEE. AR Scanned by CamScanner 1 A. ALTERATIONS. LESSEE shall not make structural alterations or additions of any kind to the leased premises, but may make nonstructural alterations provided LESSOR consents thereto in writing, which consent shall not be unreasonably withheld or delayed. All such alterations shall be at LESSEE'S expense and shall be in quality at least equal to the present construction. LESSEE shall not permit any mechanics' liens, or similar liens, to remain upon the leased premises in connection with work of any character performed or claimed to have been performed at the direction of LESSEE and shall cause any such lien to be released or removed forthwith without cost to LESSOR. Any alterations or improvements made by the LESSEE shall become part of the real estate and the property of LESSOR. 11. LESSOR'S ACCESS. LESSOR or agents of LESSOR may at reasonable times enter to view the leased premises and may remove any signs not approved and affixed as herein provided, and may make repairs and alterations as LESSOR should elect to do and repairs which LESSEE is required but has failed to do, and may show the leased premises to others. However, access to the premises shall be with the prior consent of LESSEE,which consent shall not unreasonably be withheld. As provided by law, in the case of an emergency, LESSOR nay enter the premises without LESSEE'S express consent. 12. DANGEROUS MATERIALS. LESSEE shall not keep or have on the premises any article or thing of a dangerous, inflammable or explosive character that might substantially increase the danger of fire on the premises, or that might be considered hazardous by an insurance company, unless the prior written consent of LESSOR is obtained and proof of adequate insurance protection is provided by LESSEE to LESSOR. 13. REAL ESTATE TAXES. LESSOR shall be responsible for payment of all real estate taxes for the leasehold premises and the remainder of the building. 14. SIGNS. LESSEE shall obtain the written consent of LESSOR before erecting any sign on leased premises. Without waiving the requirement that LESSEE satisfy applicable local and state regulations, LESSOR approved the location,shape and size of sign attached hereto. 15. ACCESS AND PARKING. LESSEE shall have the right without additional charge to use parking facilities, but not including parking spaces marked "Visitor" or"Reserved", in common with others entitled to the use thereof, and said parking area or any portion thereof shall be considered an extension of the leased premises to the extent that it is utilized by LESSEE or LESSEE'S employees. LESSEE will not obstruct in any manner any portion of the building or the walkways or approaches to said building, and will conform to all reasonable rules now or hereafter made by LESSOR for parking, and for the care, use or alteration of the building, its facilities or approaches. LESSEE further warrants that LESSEE will not permit any employee or visitor to violate this or any other covenant or obligation of LESSEE. Unregistered vehicles may not be parked at any time and LESSEE agrees to assume all expense and risk for the towing of any mis-parked vehicle belonging to LESSEE or LESSEE'S agents,employees,or business invitees at any time. 16. OCCUPANCY. In case the LESSEE takes possession of said premises prior to the start of said term, LESSEE will perform and observe all of LESSEE'S covenants from the date upon which LESSEE takes possession except the obligation for the payment of extra rent. LESSEE shall not remove or attempt to remove LESSEE'S goods or property from the leased premises other than in the ordinary and usual course of business, without having first paid and satisfied LESSOR for all rent which may become due during the entire term of this Lease. AR Scanned by CamScanner from the sources from which they are usually obtained for said building, or to any other cause beyond the LESSOR'S immediate control. 22. DEFAULT AND BANKRUPTCY. In the event that: (a) LESSEE shall be declared bankrupt or insolvent according to law, or if any assignment shall be made of LESSEE'S property for the benefit of creditors; or (b) LESSEE shall default in the payment of any installment of rent or other sum herein specified and spch default shall continue for ten (10) days after written notice thereof; or (c) LESSEE shall default in the observance or performance of any other of LESSEE'S covenants, agreements, or obligations hereunder and such default shall not be corrected (or be very actively in the process of being corrected) within thirty (30) days after written notice thereof, or (d) LESSEE vacates the premises or permits them to be unoccupied for more than ten (10) days, the LESSOR shall have the right thereafter, while such default continues, and without demand or further notice, to re-enter and take complete possession of the leased premises, to declare the term of this Lease ended, and to remove LE'SSEE'S effects, without being guilty of any manner of trespass and without prejudice to any remedies which might be otherwise used for arrears of rent or other default or breach of covenant. LESSEE shall indemnify LESSOR against all loss of rent and other payments which LESSOR may incur by reason of such termination during the remainder of the term. if LESSEE shall default,after reasonable notice thereof, in the observance or performance of any other conditions or covenants on LESSEE'S part to be observed or performed under or by virtue of any of the provisions in any article of this Lease, LESSOR, without being under any obligation to do so and without thereby waiving such default, may remedy same for the account and at the expense of LESSEE. If LESSOR pays or incurs any obligation for the payment of money in connection therewith, including but not limited to reasonable attorney's fee in instituting, prosecuting or defending any action or proceeding,such sums paid or obligations incurred, with interest at the rate of ten percent per annum and costs, shall be paid to LESSOR by LESSEE as additional rent. Upon default of this Lease by LESSEE, entire balance of rent which would accrue hereunder shall at the option of LESSOR become immediately due and payable. Notwithstanding the foregoing, LESSEE agrees to pay reasonable attorney's fees incurred by LESSOR in enforcing any or all obligation of LESSEE under this LEASE at any time. 23. NOTICE. Any notice from LESSOR to LESSEE relating to the leased premises or to the occupancy thereof, shall be deemed duly served, if left at the leased premises addressed to LESSEE, or if sent to the leased premises by certified mail return receipt requested, postage prepaid, addressed to LESSEE. Any notice from LESSEE to LESSOR shall be deemed duly served if sent to LESSOR by certified mail, return receipt requested, postage prepaid, addressed to LESSOR at 30 Massachusetts Avenue,North Andover,MA 01845 or at such address as LESSOR has last designated. 24. SURRENDER. LESSEE shall at the time of expiration or other termination of this Lease remove all of LESSEE'S goods and effects from the leased premises. LESSEE shall deliver to LESSOR the Leased Premises and all keys, locks thereto. LESSEE shall deliver at the commencement of the term, or as they were put in during the term hereof,reasonable wear and tear and damage by fire or other casualty only excepted. In the event of LESSEE'S failure to remove any of LESSEE'S property from the premises, LESSOR is hereby and at the sole risk of LESSEE to remove and store any such property at LESSEE'S expense, or to retain same under LESSOR'S control or to sell at public or private sale,without notice, any or all of the property not so removed and to apply the net proceeds of such sale to the payment of any sum due hereunder,or to destroy such property. 25. OUTSIDE AREA. No goods or things of any type or description shall be held or stored outside the leased premises at any time without the express written approval of LESSOR. AR Scanned by CamScanner exercise of such option, and provided further that LESSEE is not at the time of such exercise in default under any of the provisions of this Lease Agreement. 32. FIT-UP. LESSOR agrees to remove wallpaper in the comer office and the reception area. Walls are to be repainted by The LESSOR. In addition, the LESSOR will construct a wall that creates a reception area and separates the Leased Premises from the common area. The wall will have a glass entry door. The attached plan,"Exhibit A",shows the location of the wall. LESSEE agrees to vacate the corner office while work is being completed. Office is to be free of all of the LESSEE's belongings. In the event that the agreed work is not complete by January 1, 2018 it is agreed that the Lease commencement date will adjust to the Monday following completion. If the commencement date is other January 1, 2018 it will be acknowledged by the parties through the execution of a "Memorandum of Lease Commencement". All of the fit-up mentioned above shall be at the cost of the LESSOR. IN WITNESS WHEREOF, LESSOR AND LESSEE have hereunto set their hands and common seals and intend to be legally bound hereby this th day of December,2017. Lessee: Lessor: Crossway Homecare LLC Discovery Bay Holdings LLC By: By_ nnon Njorog a er � Arthur H. Richter, Manager Scanned by CamScanner --- ------- aicwcu lnwt FISCAL YEAR 2018 Account No: 001-217.0-0076-0000.0 PERSONAL PROPERTY TAX Business Name: CROSSWAY HOME CARE Fiscal Year 2018 Tax $72.56 Business Location : MASSACHUSETTS AVE 30 Description Valuation Preliminary Tax: $34.77 501-Pers.prop.indiv,partner.,trust $ 3,400 3rd Installment: $18.90 Fiscal Year 2018 Tax $72.56 Payment due by February 01,2018 Rate per S1000 of Valuation s 21.34 4th Installment: $18.89 Interest at the rate of 14%per annum will accrue on overdue Payment due by May 01,2018 date until payment is made. Tax Paid : $0.00 ABATEMENT APPLICATIONS MUST BE RECEIVED BY THE Abatement: $0.00 ASSESSOR'S OFFICE NO LATER THAN January 31,2018 Interest as of $3.87 May 08,2018 Amount Now Due: $ 76.43 FISCAL YEAR 2018 PERSONAL PROPERTY TAX BILL 2813 [OWN OF NORTH ANDOVER OFFICE OF THE COLLECTOR OF TAXES I u „�1111111111��IIIN oil III 1111111111 '.O.BOX 124 THE COMMONWEALTH OF MASSACHUSETTS VORTH ANDOVER,MA 01845 TOWN OF NORTH ANDOVER of-F 8:30-4:30 422071701 CAX 688-9550/ASSR 688-9566 Tax Unpaid Message kccount No: 001-217.0-0076-0000.0 1st Installment $17.39 Tax bills may be paid at Town Hall,120 Main Street,or 3usiness Name:CROSSWAY HOME CARE 2nd Installment $17.38 mailed to:P.0.Box 124,North Andover,MA 01845. ocation: MASSACHUSETTS AVE 30 3rd Installment $18.90 4th Installment $18.89 CROSSWAY HOME CARE 4TH PAYMENT RECEIPT VOUCHER 30 MASSACHUSETTS AVE STE306B Payment due by May 01,2018 NORTH ANDOVER,MA Amount Now Due: $ 76.43 01845 Based upon assessments as of Jan.01,2017 your Personal Property tax -- - for the fiscal year commencing July 01,2017 and ending on lune 30,2018 on the described property below is as follows: 628 04220717012018000000000000000000000200002813000000007643049 FISCAL YEAR 2017 Account No: 001-217.0-0076-0000.0 PERSONAL PROPERTY TAX Business Name: CROSSWAY HOME CARE Fiscal Year 2017 Tax $82.82 Business Location : MASSACHUSETTS AVE 30 Description Valuation Preliminary Tax: $0.00 501-Pers.prop.indiv,partner.,trust $ 4,050 3rd Installment: $41.41 Fiscal Year 2017 Tax $82.82 Payment due by February 01,2017 Rate per$1000 of Valuation S 20.45 4th Installment: $41.41 Interest at the rate of 14%per annum will accrue on overdue Payment due by May 01,2017 date until payment is made. Tax Paid : $0.00 ABATEMENT APPLICATIONS MUST BE RECEIVED BY THE Abatement: $0.00 ASSESSOR'S OFFICE NO LATER THAN January 31,2017 Interest as of $0.00 Amount Now Due: $ 112.82 FISCAL YEAR 2017 PERSONAL PROPERTY TAX BILL 21669 TOWN OF NORTH ANDOVER OFFICE OF THE COLLECTOR OF TAXES P.O.BOX 124 THE COMMONWEALTH OF MASSACHUSETTS I lulu 11111111111111111111111111 Bill NIII VIII VIII Illi IpI NORTH ANDOVER,MA 01845 TOWN OF NORTH ANDOVER M-F 8:30-4:30 421703656 TAX 688-9550/ASSR 688-9566 Tax Unpaid Message Account No: 001-217.0-0076-0000.0 1st Installment $0.00 Tax bills may be paid at Town Hall,120 Main Street,or Business Name:CROSSWAY HOME CARE 2nd Installment $0.00 mailed to:P.O.Box 124,North Andover,MA 01845. Location: MASSACHUSETTS AVE 30 3rd Installment $41.41 4th Installment $71.41 CROSSWAY HOME CARE 4TH PAYMENT RECEIPT VOUCHER 30 MASSACHUSETTS AVE STE306B Payment due by May 01,2017 NORTH ANDOVER,MA Amount Now Due: $ 112.82 01845 - Based upon assessments as of Jan.01,2016 your Personal Property tax for the fiscal year commencing July 01,2016 and ending on June 30,2017 on the described property below is as follows: 52 04217036562017000000000000000000000200021669000000011282042 AC R® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYY1) lilb. � 1 05/10/2018 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(les)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). PRODUCERONTACT Anna Lukas NAME: T.Edmund Garrity&Co.,Inc. PH_IAONENo. (617)354-4640 FAX No: (617)354-5828 545 Concord Avenue,Suite 16 E-MAIL annie@gardty-insurance.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC 0 Cambridge MA 02138 INSURERA: Atain Specialty Ins Co INSURED INSURER B: Commerce Ins.Co. 34754 CroSS'Nay Transit LLC INSURER C: 30 Mass Ave Ste 409 INSURER D: INSURER E: N Andover MA 01845 INSURER F: COVERAGES CERTIFICATE NUMBER: master COI 2018 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 LTR TYPE OF INSURANCE I POLICY NUMBER MMIDD/YYYY MM/LDD LIMITS X COMMERCIAL GENERAL LIABILITY 1,000,000 EACH OCCURRENCE $ DAMAGE100,000 CLAWS-MADE X OCCUR PR MI E occurrence $ MED EXP(Any one pens n) $ 5,000 A CIP344242 05/01/2018 05/01/2019 PERSONAL&ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 3,000,000 X POLICY ❑ Pita 2,000,000 JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ _ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT s 1,000,000 Ea accident ANYAUTO BODILY INJURY(Per person) $ B OWNED SCHEDULED TBA 04/27/2018 04/27/2019 BODILY INJURY(Per accident) $ AUTOS ONLY x AUTOS X HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident S UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATIONPT TOTE ETH AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETORIPARTNER/EXECUTIVE I--', NIA E.L EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be aftached H mora space is reciulmd) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Element Care LLC ACCORDANCE WITH THE POLICY PROVISIONS. 37 Friend Street AUTHORIZED REPRESENTATIVE Lynn MA 01902 L-.� ` ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 26(2016/03) The ACORD name and logo are registered marks of ACORD -- -� Mass.Corporations,external master page �4�SN►S ',I William Francis Galvin L Secretary tiff a iy `• of • • of ssywatio Corporations Division Business Entity Summary ID Number: 001324842 Request certificate I New search Summary for: CROSSWAY TRANSIT LLC The exact name of the Domestic Limited Liability Company (LLC): CROSSWAY TRANSIT LLC Entity type: Domestic Limited Liability Company (LLC) Identification Number: 001324842 Date of Organization in Massachusetts: 04-26-2018 Last date certain: The location or address where the records are maintained (A PO box is not a valid location or address): Address: City or town, State, Zip code, Country: The name and address of the Resident Agent: Name: JOHN NJOROGE Address: 30 MASS AVE, SUITE 409 City or town, State, Zip code, NORTH ANDOVER, MA 01845 USA Country: The name and business address of each Manager: "Fit e individual name Address MANAGER DANIEL KANGETHE 30 MASS AVE, SUITE 409 NORTH ANDOVER, MA 01845 USA MANAGER SHANNON NJOROGE 30 MASS AVE, SUITE 409 NORTH ANDOVER, MA 01845 USA MANAGER JOHN NJOROGE 30 MASS AVE, SUITE 409 NORTH ANDOVER, MA 01845 USA MANAGER KANGETHE WANIA 30 MASS AVE, SUITE 409 NORTH ANDOVER, MA 01845 USA In addition to the manager(s), the name and business address of the person(s) authorized to execute documents to be filed with the Corporations Division: Titie individual name Address SOC SIGNATORY JOHN NJOROGE 30 MASS AVE, SUITE 409 NORTH ANDOVER, ittp://corp.sec.state.ma.us/CorpWeb/CorpSearch/CorpSummary.aspx?FEIN=001324842&SEARCH_TYPE=1 1/2 TOWN OF NORTH ANDOVER Page:1/1 TAX SHEET Account No Community# Input Date Nbad Status Total Growth 126120 06/09/2016 3,400 0 DBA CROSSWAY HOME CARE Last Year 2 Year Back 3 Year Back Owner CROSSWAY HOME CARE 3,400 4,050 0 Location 30 MASSACHUSETTS AVE Tax Code 501 Business Type ELCA Phone 978 - 683-3000 Mail Address 30 MASSACHUSETTS AVE STE3068 Data Lister LG Entry Clerk CC Last Activity 06/13/2016 List Date 06/07/2016 NORTH ANDOVER,MA 01845 Sources LG Email ID OLD ACCT# 001/217.0-0076 CHANGE DA LAST FOL? BY WHO Type Description YearNew PriceCode Depreciation Itemcost Qty ReplaceCost TotalValue Property Details: F DESK(AVG) 2010 1362 A 65 550 1 550 360 F CHAIR(SWIVEL GOOD) 2010 4861 A 65 375 1 375 240 F CHAIR(W/ARMS) 2010 1353 A 65 115 2 230 150 F FILE CABINET(4 DR AVG) 2010 1368 A 65 220 2 440 290 M PHONE SYSTEM(SMALL) 2015 4611 E 79 1,100 1 1,100 870 M FAX 2015 5058 X 70 300 1 300 210 M COMPUTER(PERSONAL) 2015 5049 X 70 1,500 1 1,500 1,050 M COMPUTER PR(DESK JET) 2015 5057 X 70 300 1 300 210 S SUPPLIES 2016 9999 S 100 20 1 20 20 Property Totals: FURNITURE 1,040 MACHINERY 2,340 SUPPLIES 20 Grand Total Assessment 3,400 Penalty 0 Assessment +Penalty 3,400 05/08/2018 03:29 PM Real Estate Research Consultants,inc SGC Lease Amendment Discovery Bay Holdings LLC and Crossway Homecare LLC being parties to a lease agreement executed on January 26, 2018, mutually agree to modify the Lessee. The sole purpose of the modification is to add a second Lessee. No other changes, additions or deletions are intended. The current Lessee, as shown in paragraph 1 of the Lease Agreement, is Crossway Homecare LLC. The Lessee as amended is Crossway Homecare LLC and Crossway Transit LLC. Agreed this 11th day of July, 2018. Crossway Homecare LLC Discovery M Holdings LLC / fil -B Shannon Njoroge, anager Arthur VAchter, Manager Crossway Transit LLC tom_, John N' roge, Manager Scanned by CarnScanner IIIIIIIIII IIIIIIIIIIIII IIIIIIIIIIII I I IIIII I III II III I IIIIII IIIIII IIIIIIIIIIIII III IIIIIIII IIIII I IIIIIIIIIIIIIII II * K G 0 0 0 0 3 1 0 0 W C 3 1 6 1 8 9 6 9 0 1 0 1 1 0 0 0 8T0-6968T9-ST£-SaM 8£Tzo vw aoaixswv aAV axoOHoo SVS ONI oo 1 xsIEUVE) GNnwa:ff s W 0 0608-z0VV9 IM 'rivsnKM 0608 xos oa sxozsVx:ffao Ssax'MM xxVsrulzonru anoxo WflLnw xsu:ffgiz _ Liberty Mutual. INSURANCE RE: WC5-31S-618969-018 CROSSWAY TRANSIT LLC 30 MASS AVE STE 409 N ANDOVER, MA 01845 Dear Producer: We are pleased to provide you a copy of the above policyholder's Workers Compensation policy. Included in this package is contact information for Liberty Mutual servicing departments. We mailed the policyholder their copy of the policy separately and provided a supply of claim reporting forms with instructions on how to file a claim. Producers of assigned risk business are now able to expedite the processing of Certificates of Workers' Compensation Insurance for Massachusetts employees by requesting the certificates of insurance through the Certificate Tool on the MA Bureau's website www.wcribma.com. For all other states, you may issue Certificates of Workers Compensation Insurance using the authorized ACORD form on their website www.acord.com. Please provide a copy of the Certificates of Insurance you issue for policyholders of Liberty Mutual to us via email to IMS(cLibertyMutual.com, or send to Liberty Mutual, PO Box 8090, Wausau, WI 54402-8090. Please contact us with any questions or if we can be of any assistance to help you service your policyholder. Sincerely, Commercial Service Operations CNW 90 06 1117 ©2016 Liberty Mutual Insurance. All rights reserved. Broker Copy LIBERTY MUTUAL WORKERS COMPENSATION, GROUP BENEFITS,AND HELMSMAN MANAGEMENT SERVICES, LLC PRIVACY PRACTICES DISCLOSURE NOTICE This Privacy Practices Disclosure Notice outlines the privacy practices for Liberty Mutual Insurance and its subsidiaries and affiliates listed below(collectively referred to as "Liberty Mutual'): Liberty Mutual Fire Insurance Company - Liberty Insurance Corporation - LM Insurance Corporation - The First Liberty Insurance Corporation Liberty Insurance Company of America - Liberty Northwest Insurance Corporation - Liberty Life Assurance Company of Boston - Helmsman Management Services, LLC - Employers Insurance Company of Wausau - Wausau General Insurance Company Wausau Business Insurance Company - Wausau Underwriters Insurance Company This Notice tells you: - The categories of nonpublic personal information (NPPI) we collect from you or from a third party about you or about participants, beneficiaries or claimants under your workers compensation and/or group benefit coverage, or your employee benefit programs or plans; - How we use NPPI; - The categories of affiliates and non-affiliate third parties with whom we share NPPI; - The security policies and procedures in place to protect the confidentiality and security of NPPI provided to us. If you have questions regarding this Privacy Practices Disclosure Notice, contact us by sending an email to pstprivacy@libertymutual.com or write to us at: Presidential Service Team Liberty Mutual Insurance 175 Berkeley Street Boston, MA 02116 If applicable, please include your policy number or contract number with any correspondence. 1. INFORMATION WE MAY COLLECT We want you to conduct business with us knowing that we protect NPPI. We collect NPPI from you or from third parties about you or about participants, beneficiaries or claimants under your insurance coverage. We collect NPPI from: - Applications or other forms which may include policyholder, participant, beneficiary or claimant name, address, phone number, social security number, household information, vehicle and driver information, date of birth, medical information related to underwriting and claims, insurance coverage, and employee benefit programs or plan information; - Your business dealings with us, our affiliates, or others, such as prior claims or accidents, medical information related to claims, information about your accident or injury (if applicable), and the names of witnesses and other contact information; and - Consumer reporting agencies, motor vehicle departments, and inspection services. GPO 4756 R5 ©2012 Liberty Mutual Insurance. All rights reserved. Page 1 of 2 Ed. 01/01/2013 Broker Copy 2. HOW THE INFORMATION IS USED We use NPPI: - To provide policy and premium quotes; - To underwrite applications, administer claims, and answer questions about our insurance products and services; - For account administration and processing premium billings payments; - To process and defend insurance claims, and administer insurance benefits (including utilization review activities); - To report, investigate, or prevent fraud or material misrepresentation; and - As otherwise required or permitted by federal or state law. 3. TO WHOM INFORMATION IS DISCLOSED We do not disclose NPPI about you or about participants, beneficiaries or claimants under your insurance policy, employee benefit programs or plans to anyone, unless allowed by law. We are allowed by law to provide NPPI to: - A third party that performs services for us, such as claims investigations or medical examinations; - Our affiliated companies and reinsurers; - Insurance regulators, reporting agencies or, if applicable, involuntary market administrators; - State Motor Vehicle Departments to obtain a report of any accidents or convictions; - Law enforcement agencies or other governmental authorities to report suspected illegal activities; - Persons or organizations conducting insurance actuarial or research studies, subject to appropriate confidentiality agreements; - Companies that provide marketing services on our behalf,or as part of a joint marketing agreement; and, - As otherwise permitted or required by law. 4. HOW WE PROTECT INFORMATION We maintain physical, electronic, and procedural safeguards to guard NPPI. These safeguards comply with applicable laws. We retain NPPI for as long as required by law or regulation. The only employees or agents who have access to your NPPI are those who must have it to provide products or services to you. We do not sell your NPPI to mass marketing or telemarketing companies. GPO 4756 R5 ©2012 Liberty Mutual Insurance. All rights reserved. Page 2 of 2 Ed. 01/01/2013 Broker Copy �. Liber Residual Market Mutual. Small Employer Survey INSURANCE Liberty Mutual Insurance is committed to providing you and your employees with high-quality, efficient service.That is why we offer valuable tools to our residual market policyholders to help you improve your safety record, and become more attractive to voluntary insurance carriers. You'll find a brief survey on the next page to help you assess areas in which we can work with you. There are many reasons companies may not qualify for the voluntary market, including an unfavorable loss history (employees frequently injured on the job). But change is possible with the tools we make available. Completing the survey will help you assess your current company practices and offer critical, basic steps to help prevent workplace injuries. Access Your Account Online With VantagePore, our free, dedicated, secure portal for Liberty Mutual Insurance customers, you'll have instant access to the account-specific information you need to manage your insurance program. Liberty Mutual SafetyNetTM is a Web-based tool designed to help risk and safety managers improve workplace safety, reduce the cost of risk, and stay compliant with federal safety standards. Resources are accessible at any time and include: • More than 200 loss control reference notes • Customizable model programs • OSHA customizable programs • Monthly e-newsletters • Industry specific pages, toolkits, and more Safety Training SafetyNetTm also offers several levels of training to suit the novice or the seasoned person responsible for safety in any organization. Seminars range from a general overview of safety issues to webinars aimed specifically at your potential and actual risk exposures. Choose the type and level of training that matches your company's specific needs—all at no additional cost to you! Accidents Happen No matter how well you prepare, accidents can happen. Liberty Mutual Insurance is ready to assist immediately when they do. With Internet ExPRSTM, you can report all of your claims online—no special software required. Notification is sent directly to our claims management system, and you have immediate online confirmation the claim was received in our office. Track Your Claims Stay on top of claims from beginning to end with RISKTRAC®CSP. Monitor claims activity, view case manager notes and action plans, set alerts, and create and view custom reports. Broker Copy LIBERTY MUTUAL INSURANCE Please complete the survey below. If you answer"No"to any of these questions, contact Liberty Mutual Insurance at the numbers below to improve your safety practices and better manage your insurance program. ................. ........ ...................I........................... ........................... .................. ................................I------:: Are You Doing Everything You Can to Prevent Accidents? ................................................................................................................................................................................ Our company has written workplace safety policies/procedures. : Yes No Management aggressively supports and encourages workplace safety. Yes No _..... ..... ...... ... "..... . ...:..... Management regularly reviews safety issues with all employees. : Yes No ................................................................................................................................................................................................................................................................................................. Management corrects unsafe acts and conditions immediately. Yes No ........................................... . ... _ ........................ _..... ..... ....... .. Our company provides safety training for all employees. Yes No ..:: .............. : ......... I.... .... Our company rewards employees for working safely. Yes ' No ---- ......................................................................... .... ......................- ..................................................................................................................................................................................................................................................................................................... Are You Doing Everything You Can to Help Injured Employees? ........... ........ Our employees have been instructed to report workplace accidents to management immediately. Yes No -.. Management is knowledgeable about accident reporting procedures. Yes No ------------------- Management understands regular communication with disabled employees fosters good relations and ; Yes No ` aids in returning the employee to work sooner. ........................ ............................. ............ ......... .............. ........ ........ ....... ............... ........... Enroll in VantagePore Call us at 800-653-7893 or email ims@libertymutual.com. A member of our team will walk you through the simple registration process. Risk Control Consulting Center Our consultants are available Monday through Friday, 8:00 a.m. to 8:00 p.m. ET. Call us toll-free at 866-757-7324 or contact us by email anytime at rcconsultingcenter@libertymutual.com. Broker Copy POLICYHOLDER INFORMATION PACKET FOR: CROSSWAY TRANSIT LLC 30 MASS AVE STE 409 N ANDOVER, MA 01845 Policy Number: WC5-31S-618969-018 Broker Copy t LibertX Mutual. INSURANCE Dear Policyholder, Enclosed along with your policy is a contact information list. Please keep this material with your insurance papers. We look forward to servicing your account again this year. Sincerely, Liberty Mutual Servicing Carrier Operations cc: Broker or Agent GPO4692 (Ed. 03/01/1997) Broker Copy Liberty Mutual® INSURANCE Your Workers Compensation Guide.... Dear Policyholder, This package contains your Liberty Mutual Insurance Workers Compensation policy and instructions for its use. It answers many questions you may have regarding Workers Compensation and outlines some steps you can take to control your Workers Compensation costs. Its contents include: 1. SERVICE DEPARTMENT CONTACTS Keep the contact information with your insurance records as a reference guide. 2. DESCRIPTION OF SERVICES Please take a moment to review the introductory information for each of our service departments. Claims material will be sent to you under separate cover. 3. YOUR WORKERS COMPENSATION POLICY Use this opportunity to confirm all policy details, including specific coverage and exposure estimates. Promptly contact your producer or our Underwriting department with any questions. We hope you find this material informative and helpful. We look forward to putting our experience to work for you. Sincerely, Commercial Service Operations cc: Broker or Agent SNW 20 05 0613 ©2013 Liberty Mutual Insurance.All rights reserved. Page 1 of 7 Broker Copy liberty Mutual. . INSURANCE Underwriting& Policy Issuance.... The Involuntary Market Operations department is responsible for underwriting and issuing your policy and subsequent changes. Underwriters review each application or request for policy change to accurately determine your premium according to applicable manuals, rates, and standards. The policy or policy change is subsequently issued to you. WHAT TO EXPECT FROM US - We will make policy changes as needed throughout the life of the policy, within 30 days of receiving the appropriate data. - We will endorse experience modifications to your policy within 30 days of receiving the information from the Plan Administrator. - We will provide loss history information at renewal and upon request. Please refer to "Contact Information At A Glance". - We will make every effort to reply to your questions or concerns as quickly as possible. WHAT WE EXPECT FROM YOU - Make your agent aware of any significant changes in your operations, including payroll estimates, legal status and classification of duties, so that your policy can be updated accordingly. - Provide prompt cooperation with request for information, including appropriate supporting documentation. CONTACT INFORMATION - Please refer to "Contact Information At A Glance". SNW 20 05 0613 ©2013 Liberty Mutual Insurance.All rights reserved. Page 2 of 7 Broker Copy L1bert): mutum. INSURANCE Premium Auditing.... The primary function of the Field Auditing Department is to determine the appropriate amount of payroll and other compensation used in calculating the final premium on your policy. WHAT TO EXPECT FROM US - We may perform an on-site audit at the beginning of your policy year to review payroll estimates and classifications. - We will contact you by phone or mail to make an appointment to conduct a final audit within 75 days of your policy expiration. - If requested information is not made available in a timely fashion, your premium will be estimated and your policy may be canceled. WHAT WE EXPECT FROM YOU Maintain appropriated records as required by the policy terms to facilitate a thorough audit. - Cooperate with our Auditors, including timely response to phone and mail inquiries. - If you are a contractor, be sure to obtain Workers Compensation certificates for any subcontractor exposure to avoid potential additional premium obligations. Keep in mind that a certificate of insurance for liability alone is not sufficient to establish the independence of a subcontractor. - Instead of a personal final audit you may be requested to complete a payroll report. If this method of audit is used, you will also be asked to submit copies of tax reports such as 940 forms. CONTACT INFORMATION - Please refer to "Contact Information At A Glance". SNW 20 05 0613 ©2013 Liberty Mutual Insurance.All rights reserved. Page 3 of 7 Broker Copy Liberty Mutual. INSURANCE Billing.... All customer billing is the responsibility of our Servicing Carrier Accounting Services operation, located in Dover, NH. Invoices and statements are mailed directly to you, with a copy to your producer of records. WHAT TO EXPECT FROM US - We will mail installment invoices for eligible payment plans 20 days prior to the due date, and payment in full is expected by the due date. - Overdue balances will result in policy cancellation. Reinstatement is contingent upon payment in full, or a pre-arranged resolution of any dispute. WHAT WE EXPECT FROM YOU - Make payments promptly to the address shown on "Contact Information At A Glance"and on each invoice.Be sure to include your payment coupon for accurate posting to your account.(Please note the separate correspondence address listed on"Contact Information At A Glance".) - Promptly direct questions or billing concerns to your produceror Liberty Mutual Insurance.Disputes must be detailed in writing,and the undisputed portion of the invoice must be paid within normal terms to avoid cancellation of the policy. CONTACT INFORMATION - Please refer to "Contact Information At A Glance". SNW 20 05 0613 ©2013 Liberty Mutual Insurance.All rights reserved. Page 4 of 7 Broker Copy oLiberty kmutua INSURANCE Vlbrkplace Safety.... Our Loss Prevention department advises insureds on workplace hazards and safety needs. Controlling accidents through good safety practices can have a positive impact on your productivity, workers compensation premium and ultimately your profitability. WHAT TO EXPECT FROM US - We are required to perform annual on-site consultations for certain businesses, based on size, type of business, or loss history. If your company meets specified criteria,we will contact you to schedule a visit. Additionally, we will perform a consultation upon request if you contact us at the address shown on "Contact Information At a Glance". - We will evaluate your accident and loss statistics to determine trends or causes, and review your operations for potential hazards. - After evaluating your existing safety activities, we will submit recommendations aimed at controlling hazards or strengthening programs. We will follow-up with you on these recommendations to assure compliance. WHAT WE EXPECT FROM YOU - If a mandatory on-site visit is required in your State you are expected to cooperate with the loss prevention representative allowing access to your operations. By taking this action you can obtain the maximum benefit from this service. - Once you receive recommendations from the on-site visit, you are required to inform us of your plan to complete the recommendations. We have a contractual obligation to obtain this information and will provide you with a paid, self-addressed return card with which to notify us. - You can contact us at any time for information, to ask questions, or to request a visit. CONTACT INFORMATION - Please refer to "Contact Information At A Glance". SNW 20 05 0613 ©2013 Liberty Mutual Insurance.All rights reserved. Page 5 of 7 Broker Copy I.ib .Lrt INSURANCE Commercial Claims.... A dedicated team of Claims Professionals will work with you to ensure that the appropriate medical care and wage benefits are timely and fairly administered to your injured worker in a cost effective manner. Our team will partner with you to develop early, effective return to work programs whenever possible. WHAT TO EXPECT FROM US - The Liberty Mutual Claims Service Team is responsible for the professional and responsive delivery of claims'services to you and your injured employees. - Within the framework of the Massachusetts works compensation law, we will thoroughly investigate claims, ensuring that employees receive prompt and appropriate medical treatment, and are returned to work promptly. WHAT WE EXPECT FROM YOU - Promptly report all claims through the 24 hour number listed on "Contact Information at a Glance"for your area of the state. Timely reporting is critical. It allows us to initiate our claims investigation and managed care programs immediately. The Managed Care Coordinator will direct your employee to an appropriate provider experience in the treatment of work related injuries. We ask that you read and understand the steps you should follow when a workplace accident happens. Under separate cover, you will be receiving detailed instructions and any necessary forms. If you need assistance, please feel free to contact us. Post the required notices in a location that is conspicuous to all of your employees. CONTACT INFORMATION - Please refer to "Contact Information At A Glance". SNW 20 05 0613 ©2013 Liberty Mutual Insurance.All rights reserved. Page 6 of 7 Broker Copy 0 Liberty Mutual® iNsuaANCE Common Questions.... Here are some commonly asked questions that my help you with your workers compensation program: - One of my employees has been injured on the job...what do I need to do? Your obligation is to report all work related injuries immediately. We strongly urge you to use our toll-free telephone number and fax numbers set up specifically to receive accident reports as soon as they occur. Prompt reporting of an injury is critical- it allows us to put all of our resources to work immediately to control your costs. Note that many jurisdictions impose penalties to employers who do not promptly report an employee's injury.Please contact your local Claims Service Team with any questions. - My policy premium is not what I expected...what happened? Premium is determined by the amount of payroll and the applicable classification codes and rates which have been established for your operations. Your premium may also be subject to an experience modification factor or All Risk Adjustment Program (ARAP) surcharge. You should carefully review each of these components with your producer to confirm your understanding of them. if you have any questions or concerns, contact our Underwriting department for further clarification or possible revision. - Why would a preliminary audit be required? A preliminary premium audit allows us to verify the payroll estimates and classifications on the policy. If there is a material difference in the projected premium due, appropriate changes can be made early in the policy period. - Why would I want to use Liberty Mutual's Safety Services? Apart from the fact that some state regulations require the use of safety services; their use is also good business! Workers compensation accidents adversely affect the premium you pay, productivity, overtime costs, and employee morale. All these factors can add to your cost of doing business. It makes economic sense to reduce accidents through a strong safety program and safe work practices. SNW 2005 0613 ©2013 Liberty Mutual Insurance.All rights reserved. Page 7 of 7 Broker Copy Libegy Mutual- INSURANCE Contact Information At A Glance........ This quick reference guide is offered to help you better manage your workers compensation coverage. Please contact your agent for assistance with your questions, or refer to the following summary information to contact us: Service Contact Information Areas of Responsibility Commercial Service Operations -Policy production Underwriting,Policy Issuance PO Box 8090 -Classifications and Rates &Customer Service Wausau WI 54402-8090 -Experience Modification Phone: (800)653-7893 -ARAP surcharges Fax: (603)334-8162 -Loss summaries E-mail:IMSQLibertyMutual.com -Self Audit Payroll Reports -Disputes Premium Audit Services -All preliminary and final Premium Auditing PO Box 9020,Mailstop 03F audit adjustments Dover,NH 03821-9020 performed by an auditor Phone: (800)231-3484 -Review of classifications Fax: (603)334-0291 -Disputes Email: IMOAuditDispute@LibertyMutual.com Premium Payments: -Premium billing Premium Billing Liberty Mutual Insurance -Premium payment PO Box 2027 processing Keene,NH 03431-7027 -Statement preparation -Collection activity Correspondence: -Disputes Commercial Service Operations PO Box 9502 Dover,NH 03821-9502 Phone: (800)653-7893 Fax: (603)334-8161 E-mail: IMS@LibertyMutual.com SNW 20 03 0116-MA(1/16) Broker Copy Risk Control-Consulting Center -Consultation Services Workplace Safety 2000 Westwood Drive -Safety Training Support Wausau,WI 54401 -Risk Control Resource Phone: (866)757-7324 Support Fax: (715)261-5119 -Safety Program Review E-mail: -SafetyNet Web Services RCConsultingCenter@LibertyMutual.com To ReROrt a Claim: -Claims investigation Claims Management& Phone: (800)362-0000 -Overall claims management Medical Care Fax: (800)969-3062 -Return-to-work programs Fraud Hotline: (800)932-3969 -Medical provider referrals Email:ciclaimreports@libertymutual.com Claim Inquiry and Correspondence: Business Insurance-WC PO Box 9525 Manchester,NH 03108 Phone: (800)562-3936 Fax: (603)334-0256 Medical Bills and Reports: Liberty Mutual Insurance 1084 South Laurel Road London,KY 40742 SNW 20 0301 16-MA(1/16) Broker Copy Liber ty mutuile INSURANCE WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY Policy Number: WC5-31S-618969-018 CROSSWAY TRANSIT LLC 30 MASS AVE STE 409 N ANDOVER MA 01845 Liberty Mutual Insurance is the marketing name for the property and casualty insurance operations. Products may be written in the following stock insurance company subsidiaries of Liberty Mutual Insurance. Liberty Mutual Insurance Company Liberty Mutual Fire Insurance Company Liberty Insurance Corporation LM Insurance Corporation The First Liberty Insurance Corporation Employers Insurance Company of Wausau Wausau Underwriters Insurance Company Wausau Business Insurance Company Wausau General Insurance Company Not all products and coverages are available in all companies and jurisdictions. WLOGO ©2012 Liberty Mutual Insurance.All rights reserved. Page 1 of 1 Ed.01/01/2013 Broker Copy NOTICE NOTICE TO TO EMPLOYEES EMPLOYEES m The Commonwealth of Massachusetts DEPARTMENT OF INDUSTRIAL ACCIDENTS 600 Washington Street, Boston, Massachusetts 02111 617-727-4900 - http://www.mass.gov/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: LM INSURANCE CORPORATION NAME OF INSURANCE COMPANY PO Box 9525, Manchester,NH 03108 (800) 562-3936 ADDRESS OF INSURANCE COMPANY WC5-31 S-618969-018 04-28-2018 04-28-2019 POLICY NUMBER EFFECTIVE DATES 545 CONCORD AVE CAMBRIDGE, T EDMUND GARRITY& CO INC MA 02138 (617) 354-4640 NAME OF INSURANCE AGENT ADDRESS PHONE# CROSSWAY TRANSIT LLC 30 MASS AVE STE 409 N ANDOVER,MA 01845 EMPLOYER ADDRESS EMPLOYER'S WORKERS' COMPENSATION OFFICER(IF ANY) DATE MEDICAL TREATMENT The above-named insurer is required in cases of personal injuries arising out of and in the course of employment to furnish adequate and reasonable hospital and medical services in accordance with the provisions of the Workers' Compensation Act. A copy of the First Report of Injury must be given to the injured employee. The employee may select his or her own physician. The reasonable cost of the services provided by the treating physician will be paid by the insurer, if the treatment is necessary and reasonably connected to the work related injury. In cases requiring hospital attention, employees are hereby notified that the insurer has arranged for such attention at the NAME OF HOSPITAL ADDRESS TO BE POSTED BY EMPLOYER Broker Copy Miscellaneous Forms Schedule WC5-31S-618969-018 FORM NUMBER FORM NAME WORKERS COMPENSATION FORMS AND ENDORSEMENTS CNW 90 06 11-17 PRODUCER PACKAGE GPO4756 R5 01-13 PRIVACY PRACTICE DISCLOSURE NOTICE CNW 90 12 12-15 RESIDUAL MARKET SMALL EMPLOYER SURVEY GPO4621 01-96 POLICYHOLDER INFO PACKET COVER PAGE GPO4692 03-97 POLICY ENCLOSED LETTER SNW 20 05 06-13 MA WC GUIDE LETTER SNW 20 03 01-16 MA CONTACT AT A GLANCE WLOGO 01-13 LIBERTY LOGO COVER PAGE SNW 20 04 01-13 NOTICE TO EMPLOYEES WC 00 00 01 A 07-11 INFORMATION PAGE - WC 00 00 01 A GPO2923 01-96 EXTENSION OF INFO PAGE WC 99 50 04 01-15 POLICY JACKET WC 00 00 00 C Broker Copy WORKERS COMPENSATION AND EMPLOYERS LIABILITY10� INSURANCE POLICY Lib N C Et1aI® INNSUSU RAA NCE AR INFORMATION PAGE 175 Berkeley Street Boston,MA 02116 Issued by LM INSURANCE CORPORATION 27243 Policy Number WC5-31S-618969-018 Issuing Office 016C NEW BUSINESS NEW Issue Date 05-16-18 Account Number 1-618969 Sub Account 0000 1. Insured and Mailing Address CROSSWAY TRANSIT LLC RISK ID 001044483 30 MASS AVE STE 409 N ANDOVER,MA 01845 Status 46 LIMITED LIABILITY CO Other workplaces not shown above: SEE ITEM 4. PREMIUM- EXTENSION OF INFORMATION PAGE 2. Policy Period: The policy period is from 04-28-2018 to 04-28-2019 12:01 A.M. standard time at the Insured's mailing address. 3. Coverage A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: MA B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in Item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident $ 100,000 each accident Bodily Injury by Disease $ 500,000 policy limit Bodily Injury by Disease $ 100,000 each employee C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: SEE END WC 20 03 06B D. This policy includes these endorsements and schedules: SEE EXTENSION OF INFORMATION PAGE 4. Premium: The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Code Premium Basis Total Rate per$100 Estimated Annual Classifications Number Estimated Annual Remuneration of Remuneration Premium See Extension of Information Page Minimum Premium $ 309 (MA) Total Estimated Annual Premium $ 312 Premium will be billed ANNUAL Producer 0004162130 T EDMUND GARRITY & CO INC 545 CONCORD AVE CAMBRIDGE MA 02138 WC 00 00 01 A © 1987 National Council on Compensation Insurance,lnc. WC 00 00 01 B(CA) Ed. 07/01/2011 All Rights Reserved Page 1 of 1 Broker Copy Extension of Information Page WC 00 00 01 A Item 4. State of: MASSACHUSETTS Classification of Operations Premium Basis Rate Entries in this item,except as specifically provided elsewhere in this Code Estimated Total An- Per$100 Of Estimated Annual policy;do not modify any of the other provisions of this policy No. nual Remuneration Remuneration Premium 0001-01 CROSSWAY TRANSIT LLC FEIN # 82-5326742 SIC CODE 4142 NAIC CODE 485510 30 MASS AVE STE 409 N ANDOVER MA 01845 BUS CO: ALL OTHER EMPLOYEES & 7382 $ 2,000 3.72 $ 74.00 DRIVERS BUS CO: GARAGE EMPLOYEES 8385 IF ANY 2.66 $ 0.00 TOTAL CLASS PREMIUM $ 74.00 STANDARD TOTAL $ 74.00 LOSS CONSTANT 0032 $ 20.00 EXPENSE CONSTANT 0900 $ 159.00 TERRORISM RISK INS ACT 2002 .03 9740 $ 1.00 POLICY MINIMUM DIFFERENCE 0990 $ 55.00 MACHWC (SURCHARGE) 1.0456 0936 $ 3.00 FINAL TOTAL $ 312.00 POLICY TOTAL ESTIMATED COST $ 312.00 Experience Wlodification: RISK ID: 001044483 Policy No. WC5-31S-618969-018 Page No. 1 GPO 2923 WC 00 00 01 A Broker Copy Extension of Information Page WC 00 00 01 A Endorsement Schedule WC5-31S-618969-018 FORM NUMBER FORM NAME WORKERS COMPENSATION FORMS AND ENDORSEMENTS WC 00 04 14 NOTIFICATION OF CHANGE IN OWNERSHIP ENDT WC 00 04 22 B TERRORISM RISK PGM REAUTH ACT DISCL ENDT WC 20 03 01 MA LIMITS OF LIABILITY ENDT WC 20 03 02 A MA ASSESSMENT CHARGE WC 20 03 03 D MA NOTICE TO POLICYHOLDER ENDT WC 20 03 06 B MA LIMITED OTHER STATES INSURANCE WC 20 03 07 MA A/R POOL ELIGIBILITY ENDT WC 20 04 05 MA PREMIUM DUE DATE ENDT WC 20 06 01 A MA CANCELLATION ENDT WC 20 06 04 MA POLICY DEFINITION ENDT WC 00 00 01 A Broker Copy WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY QUICK REFERENCE Beginning on Page General Section A. The Policy 2 B. Who is Insured 2 C. Workers Compensation Law 2 D. State 2 E. Locations 2 Part One—Workers Compensation Insurance A. How This Insurance Applies 2 B. We Will Pay 2 C. We Will Defend 2 D. We Will Also Pay 2 E. Other Insurance 3 F. Payments You Must Make 3 G. Recovery From Others 3 H. Statutory Provisions 3 Part Two— Employers Liability Insurance A. How This Insurance Applies 3 B. We Will Pay 4 C. Exclusions 4 D. We Will Defend 4 E. We Will Also Pay 5 F. Other Insurance 5 G. Limits of Liability 5 H. Recovery From Others 5 I. Actions Against Us 5 Part Three—Other States Insurance A. How This Insurance Applies 6 B. Notice g Part Four—Your Duties If Injury Occurs 6 Part Five- Premium A. Our Manuals g B. Classification g C. Remuneration g D. Premium Payments 7 E. Final Premium 7 F. Records 7 G. Audit 7 Part Six- Conditions A. Inspection 7 B. Long Term Policy 7 C. Transfer of Your Rights and Duties 7 D. Cancellation 8 E. Sole Representative 8 Important: This Quick Reference is not part of the Workers Compensation and Employers Liability Policy and does not provide coverage. Refer to the Workers Compensation and Employers Liability Policy itself for actual contractual provisions. PLEASE READ THE WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY CAREFULLY. WC 00 00 00 C ©2013 Liberty Mutual Insurance WC 99 50 04 Ed. 01/01/2015 Contains copyrighted materials of the National Council on Compensation Page 1 of 8 Insurance, Inc., used with its permission. Broker Copy WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY In return for the payment of the premium and subject to all terms of this policy, we agree with you as follows: GENERAL SECTION A. The Policy This policy includes at its effective date the Information Page and all endorsements and schedules listed there. It is a contract of insurance between you (the employer named in Item 1 of the Information Page) and us (the insurer named on the Information Page). The only agreements relating to this insurance are stated in this policy. The terms of this policy may not be changed or waived except by endorsement issued by us to be part of this policy. B. Who is Insured You are insured if you are an employer named in Item 1 of the Information Page. If that employer is a partnership, and if you are one of its partners, you are insured, but only in your capacity as an employer of the partnership's employees. C. Workers Compensation Law Workers Compensation Law means the workers or workmen's compensation law and occupational disease law of each state or territory named in Item 3.A. of the Information Page. It includes any amendments to that law which are in effect during the policy period. It does not include any federal workers or workmen's compensation law, any federal occupational disease law or the provisions of any law that provide nonoccupational disability benefits. D. State State means any state of the United States of America, and the District of Columbia. E. Locations This policy covers all of your workplaces listed in Items 1 or 4 of the Information Page; and it covers all other workplaces in Item 3.A. states unless you have other insurance or are self-insured for such workplaces. PART ONE—WORKERS COMPENSATION INSURANCE A. How This Insurance Applies This workers compensation insurance applies to bodily injury by accident or bodily injury by disease. Bodily injury includes resulting death. 1. Bodily injury by accident must occur during the policy period. 2. Bodily injury by disease must be caused or aggravated by the conditions of your employment. The employee's last day of last exposure to the conditions causing or aggravating such bodily injury by disease must occur during the policy period. B. We Will Pay We will pay promptly when due the benefits required of you by the workers compensation law. C. We Will Defend We have the right and duty to defend at our expense any claim, proceeding or suit against you for benefits payable by this insurance. We have the right to investigate and settle these claims, proceedings or suits. We have no duty to defend a claim, proceeding or suit that is not covered by this insurance. D. We Will Also Pay We will also pay these costs, in addition to other amounts payable under this insurance, as part of any claim, proceeding or suit we defend: 1. reasonable expenses incurred at our request, but not loss of earnings; 2. premiums for bonds to release attachments and for appeal bonds in bond amounts up to the amount payable under this insurance; 3. litigation costs taxed against you; WC 00 00 00 C ©2013 Liberty Mutual Insurance WC 99 50 04 Ed. 01/01/2015 Contains copyrighted materials of the National Council on Compensation Page 2 of 8 Insurance, Inc., used with its permission. Broker Copy 4. interest on a judgment as required by law until we offer the amount due under this insurance; and 5. expenses we incur. E. Otherinsurance We will not pay more than our share of benefits and costs covered by this insurance and other insurance or self-insurance. Subject to any limits of liability that may apply, all shares will be equal until the loss is paid. If any insurance or self-insurance is exhausted, the shares of all remaining insurance will be equal until the loss is paid. F. Payments You Must Make You are responsible for any payments in excess of the benefits regularly provided by the workers compensation law including those required because: 1. of your serious and willful misconduct, 2. you knowingly employ an employee in violation of law; 3. you fail to comply with a health or safety Jaw or regulation; or 4. you discharge, coerce or otherwise discriminate against any employee in violation of the workers compensation law. If we make any payments in excess of the benefits regularly provided by the workers compensation law on your behalf, you will reimburse us promptly. G. Recovery From Others We have your rights, and the rights of persons entitled to the benefits of this insurance, to recover our payments from anyone liable for the injury. You will do everything necessary to protect those rights for us and to help us enforce them. H. Statutory Provisions These statements apply where they are required by law. 1. As between an injured worker and us, we have notice of the injury when you have notice. 2. Your default or the bankruptcy or insolvency of you or your estate will not relieve us of our duties under this insurance after an injury occurs. 3. We are directly and primarily liable to any person entitled to the benefits payable by this insurance. Those persons may enforce our duties, so may an agency authorized by law. Enforcement may be against us or against you and us. 4. Jurisdiction over you is jurisdiction over us for purposes of the workers compensation law. We are bound by decisions against you under that law, subject to the provisions of this policy that are not in conflict with that law. 5. This insurance conforms to the parts of the workers compensation law that apply to: a. benefits payable by this insurance; b. special taxes, payments into security or other special funds, and assessments payable by us under that law. 6. Terms of this insurance that conflict with the workers compensation law are changed by this statement to conform to that law. Nothing in these paragraphs relieves you of your duties under this policy. PART TWO—EMPLOYERS LIABILITY INSURANCE A. How This Insurance Applies This employers liability insurance applies to bodily injury by accident or bodily injury by disease. Bodily injury includes resulting death. 1. The bodily injury must arise out of and in the course of the injured employee's employment by you. 2. The employment must be necessary or incidental to your work in a state or territory listed in Item 3.A. of the Information Page. 3. Bodily injury by accident must occur during the policy period. WC 00 00 00 C ©2013 Liberty Mutual Insurance WC 99 50 04 Ed. 01/01/2015 Contains copyrighted materials of the National Council on Compensation Page 3 of 8 Insurance, Inc., used with its permission. Broker Copy 4. Bodily injury by disease must be caused or aggravated by the conditions of your employment. The employee's last day of last exposure to the conditions causing or aggravating such bodily injury by disease must occur during the policy period. 5. If you are sued, the original suit and any related legal actions for damages for bodily injury by accident or by disease must be brought in the United States of America, its territories or possessions, or Canada. B. We Will Pay We will pay all sums that you legally must pay as damages because of bodily injury to your employees, provided the bodily injury is covered by this Employers Liability Insurance. The damages we will pay, where recovery is permitted by law, include damages: 1. For which you are liable to a third party by reason of a claim or suit against you by that third party to recover the damages claimed against such third party as a result of injury to your employee; 2. For care and loss of services; and 3. For consequential bodily injury to a spouse, child, parent, brother or sister of the injured employee; provided that these damages are the direct consequence of bodily injury that arises out of and in the course of the injured employee's employment by you; and 4. Because of bodily injury to your employee that arises out of and in the course of employment, claimed against you in a capacity other than as employer. C. Exclusions This insurance does not cover: 1. Liability assumed under a contract. This exclusion does not apply to a warranty that your work will be done in a workmanlike manner; 2. Punitive or exemplary damages because of bodily injury to an employee employed in violation of law; 3. Bodily injury to an employee while employed in violation of law with your actual knowledge or the actual knowledge of any of your executive officers; 4. Any obligation imposed by a workers compensation, occupational disease, unemployment compensation, or disability benefits law, or any similar law; 5. Bodily injury intentionally caused or aggravated by you; 6. Bodily injury occurring outside the United States of America, its territories or possessions, and Canada. This exclusion does not apply to bodily injury to a citizen or resident of the United States of America or Canada who is temporarily outside these countries; 7. Damages arising out of coercion, criticism, demotion, evaluation, reassignment, discipline, defamation, harassment, humiliation, discrimination against or termination of any employee, or any personnel practices, policies, acts or omissions; 8. Bodily injury to any person in work subject to the Longshore and Harbor Workers' Compensation Act(33 U.S.C. Sections 901 et seq.), the Nonappropriated Fund Instrumentalities Act(5 U.S.C. Sections 8171 et seq.), the Outer Continental Shelf Lands Act(43 U.S.C. Sections 1331 et seq.), the Defense Base Act(42 U.S.C. Sections 1651-1654),the Federal Mine Safety and Health Act (30 U.S.C. Sections 801 et seq. and 901-944), any other federal workers or workmen's compensation law or other federal occupational disease law, or any amendments to these laws; 9. Bodily injury to any person in work subject to the Federal Employers' Liability Act (45 U.S.C. Sections 51 et seq.), any other federal laws obligating an employer to pay damages to an employee due to bodily injury arising out of or in the course of employment, or any amendments to those laws; 10. Bodily injury to a master or member of the crew of any vessel, and does not cover punitive damages related to your duty or obligation to provide transportation, wages, maintenance, and cure under any applicable maritime law; 11. Fines or penalties imposed for violation of federal or state law; and 12. Damages payable under the Migrant and Seasonal Agricultural Worker Protection Act (29 U.S.C. Sections 1801 et seq.) and under any other federal law awarding damages for violation of those laws or regulations issued thereunder, and any amendments to those laws. D. We Will Defend We have the right and duty to defend, at our expense, any claim, proceeding or suit against you for damages payable by this insurance. We have the right to investigate and settle these claims, proceedings and suits. We have no duty to defend a claim, proceeding or suit that is not covered by this insurance. We have no duty to defend or continue defending after we have paid our applicable limit of liability under this insurance. WC 00 00 00 C ©2013 Liberty Mutual Insurance WC 99 50 04 Ed. 01/01/2015 Contains copyrighted materials of the National Council on Compensation Page 4 of 8 Insurance, Inc., used with its permission. Broker Copy E. We Will Also Pay We will also pay these costs, in addition to other amounts payable under this insurance, as part of any claim, proceeding, or suit we defend: 1. Reasonable expenses incurred at our request, but not loss of earnings; 2. Premiums for bonds to release attachments and for appeal bonds in bond amounts up to the limit of our liability under this insurance; 3. Litigation costs taxed against you; 4. Interest on a judgment as required by law until we offer the amount due under this insurance; and 5. Expenses we incur. F. Other Insurance We will not pay more than our share of damages and costs covered by this insurance and other insurance or self-insurance. Subject to any limits of liability that apply, all shares will be equal until the loss is paid. If any insurance or self-insurance is exhausted, the shares of all remaining insurance and self-insurance will be equal until the loss is paid. G. Limits of Liability Our liability to pay for damages is limited. Our limits of liability are shown in Item 3.13. of the Information Page. They apply as explained below. 1. Bodily Injury by Accident. The limit shown for "bodily injury by accident—each accident" is the most we will pay for all damages covered by this insurance because of bodily injury to one or more employees in any one accident. A disease is not bodily injury by accident unless it results directly from bodily injury by accident. 2. Bodily Injury by Disease. The limit shown for"bodily injury by disease—policy limit" is the most we will pay for all damages covered by this insurance and arising out of bodily injury by disease, regardless of the number of employees who sustain bodily injury by disease. The limit shown for"bodily injury by disease— each employee" is the most we will pay for all damages because of bodily injury by disease to any one employee. Bodily injury by disease does not include disease that results directly from a bodily injury by accident. 3. We will not pay any claims for damages after we have paid the applicable limit of our liability under this insurance. H. Recovery From Others We have your rights to recover our payment from anyone liable for an injury covered by this insurance. You will do everything necessary to protect those rights for us and to help us enforce them. I. Actions Against Us There will be no right of action against us under this insurance unless: 1. You have complied with all the terms of this policy; and 2. The amount you owe has been determined with our consent or by actual trial and final judgment. This insurance does not give anyone the right to add us as a defendant in an action against you to determine your liability. The bankruptcy or insolvency of you or your estate will not relieve us of our obligations under this Part. WC 00 00 00 C ©2013 Liberty Mutual Insurance WC 99 50 04 Ed. 01/01/2015 Contains copyrighted materials of the National Council on Compensation Page 5 of 8 Insurance,Inc., used with its permission. Broker Copy PART THREE —OTHER STATES INSURANCE A. How This Insurance Applies 1. This other states insurance applies only if one or more states are shown in Item 3.C. of the Information Page. 2. If you begin work in any one of those states after the effective date of this policy and are not insured or are not self-insured for such work, all provisions of the policy will apply as though that state were listed in Item 3.A. of the Information Page. 3. We will reimburse you for the benefits required by the workers compensation law of that state if we are not permitted to pay the benefits directly to persons entitled to them. 4. If you have work on the effective date of this policy in any state not listed in Item 3.A. of the Information Page, coverage will not be afforded for that state unless we are notified within thirty days. B. Notice Tell us at once if you begin work in any state listed in Item 3.C. of the Information Page. PART FOUR—YOUR DUTIES IF INJURY OCCURS Tell us at once if injury occurs that may be covered by this policy. Your other duties are listed here. 1. Provide for immediate medical and other services required by the workers compensation law. 2. Give us or our agent the names and addresses of the injured persons and of witnesses, and other information we may need. 3. Promptly give us all notices, demands and legal papers related to the injury, claim, proceeding or suit. 4. Cooperate with us and assist us, as we may request, in the investigation, settlement or defense of any claim, proceeding or suit. 5. Do nothing after an injury occurs that would interfere with our right to recover from others. 6. Do not voluntarily make payments, assume obligations or incur expenses, except at your own cost. PART FIVE—PREMIUM A. Our Manuals All premium for this policy will be determined by our manuals of rules, rates, rating plans and classifications. We may change our manuals and apply the changes to this policy if authorized by law or a governmental agency regulating this insurance. B. Classifications Item 4 of the Information Page shows the rate and premium basis for certain business or work classifications. These classifications were assigned based on an estimate of the exposures you would have during the policy period. If your actual exposures are not properly described by those classifications, we will assign proper classifications, rates and premium basis by endorsement to this policy. C. Remuneration Premium for each work classification is determined by multiplying a rate times a premium basis. Remuneration is the most common premium basis. This premium basis includes payroll and all other remuneration paid or payable during the policy period for the services of: 1. all your officers and employees engaged in work covered by this policy; and 2. all other persons engaged in work that could make us liable under Part One (Workers Compensation Insurance) of this policy. If you do not have payroll records for these persons, the contract price for their services and materials may be used as the premium basis. This paragraph 2 will not apply if you give us proof that the employers of these persons lawfully secured their workers compensation obligations. WC 00 00 00 C ©2013 Liberty Mutual Insurance WC 99 50 04 Ed. 01/01/2015 Contains copyrighted materials of the National Council on Compensation Page 6 of 8 Insurance, Inc., used with its permission. Broker copy ` D. Premium Payments You will pay all premium when due. You will pay the premium even if part or all of a workers compensation law is not valid. E. Final Premium The premium shown on the Information Page, schedules, and endorsements is an estimate. The final premium will be determined after this policy ends by using the actual, not the estimated, premium basis and the proper classifications and rates that lawfully apply to the business and work covered by this policy. If the final premium is more than the premium you paid to us, you must pay us the balance. If it is less, we will refund the balance to you. The final premium will not be less than the highest minimum premium for the classifications covered by this policy. If this policy is canceled, final premium will be determined in the following way unless our manuals provide otherwise: 1. If we cancel, final premium will be calculated pro rata based on the time this policy was in force. Final premium will not be less than the pro rata share of the minimum premium. 2. If you cancel, final premium will be more than pro rata; it will be based on the time this policy was in force, and increased by our short-rate cancelation table and procedure. Final premium will not be less than the minimum premium. F. Records You will keep records of information needed to compute premium. You will provide us with copies of those records when we ask for them. G. Audit You will let us examine and audit all your records that relate to this policy. These records include ledgers, journals, registers, vouchers, contracts, tax reports, payroll and disbursement records, and programs for storing and retrieving data. We may conduct the audits during regular business hours during the policy period and within three years after the policy period ends. Information developed by audit will be used to determine final premium. Insurance rate service organizations have the same rights we have under this provision. PART SIX—CONDITIONS A. Inspection We have the right, but are not obliged to inspect your workplaces at any time. Our inspections are not safety inspections. They relate only to the insurability of the workplaces and the premiums to be charged. We may give you reports on the conditions we find. We may also recommend changes. While they may help reduce losses, we do not undertake to perform the duty of any person to provide for the health or safety of your employees or the public. We do not warrant that your workplaces are safe or healthful or that they comply with laws, regulations, codes or standards. Insurance rate service organizations have the same rights we have under this provision. B. Long Term Policy If the policy period is longer than one year and sixteen days, all provisions of this policy will apply as though a new policy were issued on each annual anniversary that this policy is in force. C. Transfer of Your Rights and Duties Your rights or duties under this policy may not be transferred without our written consent. If you die and we receive notice within thirty days after your death, we will cover your legal representative as insured. WC 00 00 00 C C 2013 Liberty Mutual Insurance WC 99 50 04 Ed. 01/01/2015 Contains copyrighted materials of the National Council on Compensation Page 7 of 8 Insurance, Inc., used with its permission. Broker Copy D. Cancelation 1. You may cancel this policy. You must mail or deliver advance written notice to us stating when the cancelation is to take effect. 2. We may cancel this policy. We must mail or deliver to you not less than ten days advance written notice stating when the cancelation is to take effect. Mailing that notice to you at your mailing address shown in Item 1 of the Information Page will be sufficient to prove notice. 3. The policy period will end on the day and hour stated in the cancelation notice. 4. Any of these provisions that conflict with a law that controls the cancelation of the insurance in this policy is changed by this statement to comply with the law. E. Sole Representative The insured first named in Item 1 of the Information Page will act on behalf of all insureds to change this policy, receive return premium, and give or receive notice of cancelation. In witness whereof, LM INSURANCE CORPORATION has caused this policy to be signed by its President and its Secretary. SECRETARY PRESIDENT WC 00 00 00 C 02013 Liberty Mutual Insurance WC 99 50 04 Ed. 01/01/2015 Contains copyrighted materials of the National Council on Compensation Page 8 of 8 Insurance, Inc., used with its permission. Broker Copy WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 04 14 POLICY NUMBER:WC5-31S-618969-018 COMPANY NAME: LM INSURANCE CORPORATION NOTIFICATION OF CHANGE IN OWNERSHIP ENDORSEMENT Experience rating is mandatory forall eligible insureds. The experience rating modification factor,if any, applicable to this policy, may change if there is a change in your ownership or in that of one or more of the entities eligible to be combined with you for experience rating purposes. Change in ownership includes sales,purchases, other transfers, mergers, consolidations, dissolutions, formations of a new entity and other changes provided for in the applicable experience rating plan manual You must report any change in ownership to us in writing within 90 days of such change. Failure to report such changes within this period may result in revision of the experience rating modification factor used to determine your premium. DATE OF ISSUE: 05-16-18 Copyright 1990 National Council on Compensation Insurance. Broker Copy WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 04 22 B (Ed. 1-15) POLICY NUMBER:WC5-31S-618969-018 COMPANY NAME: LM INSURANCE CORPORATION TERRORISM RISK INSURANCE PROGRAM REAUTHORIZATION ACT DISCLOSURE ENDORSEMENT This endorsement addresses the requirements of the Terrorism Risk Insurance Act of 2002 as amended and extended by the Terrorism Risk Insurance Program Reauthorization Act of 2015. It serves to notify you of certain limitations under the Act, and that your insurance carrier is charging premium for losses that may occur in the event of an Act of Terrorism. Your policy provides coverage for workers compensation losses caused by Acts of Terrorism, including workers compensation benefit obligations dictated by state law. Coverage for such losses is still subject to all terms, definitions, exclusions, and conditions in your policy,and any applicable federal and/or state laws, rules, or regulations. Definitions The definitions provided in this endorsement are based on and have the same meaning as the definitions in the Act .If words or phrases not defined in this endorsement are defined in the Act, the definitions in the Act will apply. "Act" means the Terrorism Risk Insurance Act of 2002, which took effect on November 26, 2002, and any amendments thereto, including any amendments resulting from the Terrorism Risk Insurance Program Reauthorization Act of 2015. "Act of Terrorism" means any act that is certified by the Secretary of the Treasury, in consultation with the Secretary of Homeland Security, and the Attorney General of the United States as meting all of the following requirements: a. The act is an act of terrorism. b. The act is violent or dangerous to human life, property or infrastructure. c. The act resulted in damage within the United States,or outside of the United States in the case of the premises of United States missions or certain air carriers or vessels. d. The act has been committed by an individual or individuals as part of an effort to coerce the civilian population of the United States or to influence the policy or affect the conduct of the United States Government by coercion. "Insured Loss' means any loss resulting from an act of terrorism(and, except for Pennsylvania, including an act of war, in the case of workers compensation) that is covered by primary or excess property and casualty insurance issued by an insurer if the loss occurs in the United States or at the premises of United States missions or to certain air carriers or vessels. "Insurer Deductible" means, for the period beginning on January 1, 2015, and ending on December 31, 2020, an amount equal to 20%of our direct earned premiums, during the immediately preceding calendar year. Limitation of Liability The Act limits our liability to you under this policy. If aggregate Insured Losses exceed $100,000,000,000 in a calendar year and if we have met our Insurer Deductible,we are not liable for the payment of any portion of the amount of Insured Losses that exceeds $100,000,000,000; and for aggregate Insured Losses up to $100,000,000,000, we will pay only a pro rata share of such Insured Losses as determined by the Secretary of the Treasury. Policyholder Disclosure Notice 1. Insured Losses would be partially reimbursed by the United States Government. If the aggregate industry Insured Losses exceed: a. $100,000,000,with respect to such Insured Losses occurring in calendar year 2015, the United States Government would pay 85%of our Insured Losses that exceed our Insurer Deductible. b. $120,000,000, with respect to such Insured Losses occurring in calendar year 2016, the United States Government would pay 84%of our Insured Losses that exceed our Insurer Deductible. c. $140,000,000,with respect to such Insured Losses occurring in calendar year 2017, the United States Government would pay 83%of our Insured Losses that exceed our Insurer Deductible. d. $160,000,000,with respect to such Insured Losses occurring in calendar year 2018, the United States Government would pay 82%of our Insured Losses that exceed our Insurer Deductible. DATE OF ISSUE: 05-16-18 ©Copyright 2015 National Council on Compensation Insurance,Inc.All Rights Reserved. Broker Copy WC 00 04 22 B WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY (Ed. 1-15) POLICY NUMBER:WC5-31S-618969-018 COMPANY NAME: LM INSURANCE CORPORATION e. $180,000,000,with respect to such Insured Losses occurring in calendar year 2019, the United States Government would pay 81%of our Insured Losses that exceed our Insurer Deductible. f. $200,000,000,with respect to such Insured Losses occurring in calendar year 2020, the United States Government would pay 80%of our Insured Losses that exceed our Insurer Deductible. 2. Notwithstanding item 1 above, the United States Government will not make any payment under the Act for any portion of Insured Losses that exceed $100,000,000,000. 3. The premium charge for the coverage your policy provides for Insured Losses is included in the amount shown in Item 4 of the Information Page or in the Schedule below. Schedule State Rate Premium MA . 03 $ 1 DATE OF ISSUE: 05-16-18 WC 00 04 22 B (Ed. 1-15) ©Copyright 2015 National Council on Compensation Insurance,Inc.All Rights Reserved. Broker Copy WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 20 03 01 POLICY NUMBER:WC5-31S-618969-018 COMPANY NAME: las INSURANCE CORPORATION MASSACHUSETTS LIMITS OF LIABILITY ENDORSEMENT This endorsement applies only to the insurance provided by Part Two (Employers Liability Insurance) because Massachusetts is listed in Item 3.A.of the Information Page. Our liability to you under Section 25 of Chapter 152 of the General Laws of Massachusetts is not subject to the limit of liability thatapplies to Part Two(Employers Liability Insurance). DATE OF ISSUE: 05-16-18 Copyright 1984 National council on Compensation Insurance. Broker Copy WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 20 03 02 A (Ed. 9-08) POLICY NUMBER:WC5-31S-618969-018 COMPANY NAME: LM INSURANCE CORPORATION MASSACHUSETTS—ASSESSMENT CHARGE Massachusetts General Laws, Chapter 152, Section 65, as amended by Chapter 572 of the Acts of 1985, establishes a workers compensation special fund and a workers compensation trust fund. On behalf of the Department of Industrial Accidents (DIA), the insurance company providing workers compensation coverage is required to bill and collect an assessment charge covering the special and trust funds from insured employers and remit the amounts collected to the State Treasury. The assessment charge, which is determined by applying a rate (subject to annual change) to the DIA's standard' premium, as defined and outlined in 452 CMR 7.00, developed under your policy, is shown as a separate item on the information page of the policy. The rate may be different for private employers and for the Commonwealth and its political subdivisions. The income derived from the assessment charge will be used to fund the operating expenses of the DIA and to fund certain employee benefits as described in Chapter 152. DATE OF ISSUE: 05-16-18 WC 20 03 02 A (Ed. 9-08) ©Copyright 2008 National Council on Compensation Insurance.All Rights Reserved. Broker Copy WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WIC 20 03 03 D (Ed. 8-10) POLICY NUMBER:WC5-31S-618969-018 COMPANY NAME: Lm INSURANCE CORPORATION MASSACHUSETTS NOTICE TO POLICYHOLDER ENDORSEMENT This endorsement applies only to the insurance provided by the policy because Massachusetts is shown in Item 3.A. of the Information Page. 1. Rates and Premium The policy contains rates and classifications that apply to your type of business. If you have any questions regarding the rates or classifications, please contact your agent or us. You may obtain pertinent rating information by submitting a written request to the Workers' Compensation Rating and Inspection Bureau of Massachusetts at the address shown in this endorsement or to us at our company address shown an this endorsement. We may require you to pay a reasonable charge for furnishing the information. You may also submit a written request for a review of the method by which your classification, rates, premiums or audit results were determined. If we fail to grant or reject your request within thirty days after it is made or if you are not satisfied by the results of our review, you may submit a written request for review to the Workers' Compensation Rating and Inspection Bureau of Massachusetts CVVCRIBMN') at the address shown in this endorsement. If the V\CRIBMA fails to grant or reject your request within thirty days after it is made or[i]f you are not satisfied with the results of the WCRIBIVIA review, you may appeal to the Commissioner of Insurance at the address shown in this endorsement. 2. Reserves or Settlements You may request a loss run, which contains reserve and settlement information for claims that relate to the premium for this policy. Such a request must be in writing and should be sent to our address shown on this endorsement. We will provide you with that information within thirty(30) days of receipt of your request, and at reasonable intervals thereafter. If you have any questions or believe that we set unreasonable reserves or made unreasonable settlements that affected your premiums or losses, you may make a written request through your agent or directly to us for a meeting with our company representative. If you are not satisfied with the results of the meeting, you may make a written appeal to the Insurance Commissioner at the address shown on the endorsement. 3. Named Insured You are responsible for immediately reporting all changes in name or legal status to us in writing at the company address shown in this Endorsement. If you want to add a named insured or replace the named insured with another legal entity on any policy issued through the Massachusetts Assigned Risk Pool you must submit a new Assigned Risk Pool Application, including a Confidential Request for Information Form(ERM), to the Workers'Compensation Rating and Inspection Bureau of Massachusetts at the address shown in this Endorsement. 4. Insured's filing Address Notices relating to this Policy will be mailed or delivered to your mailing address. Your mailing address is that which is shown in Item 1 of the Information Page or in a change of address Endorsement to the Policy. You are responsible for notifying us in writing at the company address shown in this Endorsement about any change to your mailing address. DATE OF ISSUE: 05/16/2018 Copyright 2013 National Council on Compensation Insurance, Inc AJI Rights Reserved. Broker Copy WC 20 03 03 D WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY (Ed. 8-10) POLICY NUMBER:wC5-31S-618969-018 COMPANY NAME: LM INSURANCE CORPORATION Addresses The Workers'Compensation Rating and Company Address Inspection Bureau of Massachusetts LIBERTY MUTUAL INS CO Attention: Customer Service Department P. O. Box 8090 101 Arch Street, 5th Floor Boston, MA 02210 WAUSAU WI 54402-8090 www.wcribma.org Commissioner of Insurance Division of Insurance Department of Banking and Insurance 1000 Washington St 8th Floor Boston, MA 02118-2218 DATE OF ISSUE: 05/16/2018 \NC 20 03 03 D (Ed. 8-10) © Copyright 2013 National Council on Conn vv.nsation Insurance, Inc.All Rights Reserved. Broker Copy WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 20 03 06 B (Ed. 6-13) POLICY NUMBER:WC5-31S-618969-018 COMPANY NAME: LM INSURANCE CORPORATION MASSACHUSETTS LIMITED OTHER STATES BENEFIT ENDORSEMENT THIS ENDORSEMENT REPLACES PART THREE OF THE POLICY: OTHER STATES INSURANCE. A. How This Endorsement Applies 1. We do not provide other states insurance coverage as described in Part Three of the Policy. Furthermore, the Massachusetts Limited Other States Benefit Endorsement does not satisfy the requirements of another state's workers' compensation law. However, pursuant to this endorsement, we will pay promptly, when required by the workers' compensation law of a state other than Massachusetts, the benefits due to employees pursuant to such other state's law, but only if the claim for such benefits involves work performed by a Massachusetts employee. For purposes of this Endorsement, a Massachusetts employee is someone whose contract of hire was made in Massachusetts or whose work for you, as of the date of injury, has primarily been conducted in Massachusetts. Other state's benefits will not be paid if: a. The employee is claiming benefits in a state where, at the time of injury, you have other workers' compensation insurance coverage that would cover the injured employee,or b. You were, by virtue of the nature of your work or operations in that state, required by that state's law to have obtained separate workers' compensation insurance coverage in that state that would cover the injured employee. 2. If we are not permitted to pay the benefits directly to persons entitled to them under circumstances described in Item 1 above, we will reimburse you for the benefits required to be paid. 3. If you hire any employees to work outside Massachusetts or begin work or operations in any state other than Massachusetts, you must obtain any insurance coverage required by that state's laws, as this Limited Other States Benefit Endorsement does not satisfy the requirements of that state's workers' compensation insurance law. 4. This endorsement does not affect the payment of Massachusetts benefits under this Policy. DATE OF ISSUE: 05-16-18 WC 20 03 06 B (Ed. 6-13) ©Copyright 2009 National Council on Compensation Insurance,Inc.All Rights Reserved. Broker Copy i WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 20 04 05 POLICY NUMBER:WC5-31S-618969-018 COMPANY NAME: LM INSURANCE CORPORATION MASSACHUSETTS PREMIUM DUE DATE ENDORSEMENT Section D of Part Five of the Policy is replaced by this provision: PART FIVE PREMIUM D. Premium Payments is amended to read: You will pay all premium when due. You will pay the premium even if part or all of a workers compensation law is not valid. The audit and retrospective premiums shall be paid by the due date indicated on the billing statement. DATE OF ISSUE: 05-16-18 ©2000 National Council on Compensation Insurance,Inc. Broker Copy WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 20 06 01 A (Ed. 7-08) POLICY NUMBER:WC5-31S-618969-018 COMPANY NAME: LM INSURANCE CORPORATION MASSACHUSETTS CANCELLATION ENDORSEMENT This endorsement applies only to the insurance provided by the policy because Massachusetts is shown in Item 3.A. of the Information Page. The Cancellation Condition of the policy is replaced by the following: Cancellation 1. You may cancel this policy by mailing or delivering to us advance written notice requesting cancellation. Such cancellation shall not be effective until ten days after written notice is given by us to The Workers' Compensation Rating and Inspection Bureau of Massachusetts (Bureau), or until notice has been received by the Bureau that you have secured insurance from another insurance company, whichever occurs first. Our notice to the Bureau may be given by electronic transmission. 2. We may cancel this policy only if based on one or more of the following reasons: (i) nonpayment of premium; (ii) fraud or material misrepresentation affecting your policy; or(iii) a substantial increase in the hazard insured against. Such cancellation shall not be effective until ten days after written notice is given by us to you and The Workers' Compensation Rating and Inspection Bureau of Massachusetts (Bureau),or until notice has been received by the Bureau that you have secured insurance from another insurance company, whichever occurs first. Our notice to the Bureau may be given by electronic transmission. 3. We will mail or deliver the notice of cancellation to you at your last address, which shall be the mailing address shown in Item 1 of the Information Page or the change of mailing address shown in an Endorsement to the Policy. Pursuant to M.G.L. Chapter 175, Section 187C, a written notice of cancellation shall be deemed effective when mailed by us if we obtain a certificate of mailing receipt from the United States Postal Service showing your name and address as stated in the policy. 4. Any of these provisions that conflict with the law that controls the cancellation of this insurance policy is changed by this statement to comply with the law. DATE OF ISSUE: 05-16-18 WC 20 06 01 A (Ed. 7-08) ©Copyright 2008 National Council on Compensation Insurance,Inc.All Rights Reserved. Broker Copy M WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 20 06 04 POLICY NUMBER:WC5-31S-618969-018 COMPANY NAME: LM INSURANCE CORPORATION MASSACHUSETTS POLICY DEFINITION ENDORSEMENT In the General Section, Part A. -The Policy, is replaced by the following: This policy includes at its effective date the Information Page, all endorsements and schedules listed there, and your application for insurance. It is a contract of insurance between you (the employer named in Item 1 of the Information Page)and us (the insurer named on the Information Page). The only agreements relating to this insurance are stated in this policy. The terms of this policy may not be changed or waived except by endorsement issued by us to be part of this policy. DATE OF ISSUE: 05-16-18 Broker Copy TOWN OF NORTH ANDOVER OFFICE OF TOWN CLERK 120 MAIN STREET NORTH ANDOVER,MASSACHUSETTS 01845 t%ORTH Joyce A.Bradshaw,CMMCTelephone(978)688-9501 Town Clerk, 13 FAX(978)688-9557 S CH MEMORANDUM TO: Chris Nobile, Chairman, Licensing Commission Members of the Board of Selectmen Andrew Maylor, Town Manager FROM: Suzanne M. Pelich, Asst. Town Clerk DATE: August 13, 2018 SUBJECT: Request for One Day Wine &Malt License Attached please find a one day wine and malt liquor license application.from Armen Jeknavorian on behalf of St. Gregory's Church. The event is the church's Annual Picnic to be held on September 9'. They are requesting to have the fee waived, as the Board has done in the past. A favorable recommendations have bean given from the Police Department, Fire Department and Building Inspector with no conditions. Please do not hesitate to contact me if you have any questions or concerns. Thank you. 8/6/2018 Special One Day Liquor License 37742 Applicant Q Armen Jeknavorian % 978-256-2538 @ armenj@comcast.net Location 158 Main Street North Andover, Ma 01845 Event Information: Address of applicant: Type of organization: 15 Summit Ave, Chelmsford, MA 01824 Non Profit Location of Event Type of event: St. Gregory Armenian Church 158 Main St. N. Andover, MA Church Picnic Date of event: Start time of event: 09/09/2018 12:00 p.m. End time of event Type of alcohol served: 5:30 p.m. Wine and Malt Is the event being catered? Will there be use of a temporary tent? No No Will there be a generator used at the event? Will there be entertainment? No Yes **ALCOHOL MUST BE PURCHASED BY THE LICENSEE FROM AN AUTHORIZED WHOLESALER** Has permission been received from the property owner Who is serving the alcohol? to hold this event? St. Gregory Armenia Church/Armen Jeknavorian Yes Does the server have liquor liability insurance? Yes Do servers have TIPS certification?"This is required. Yes 1/2 8/7/2018 ViewPoint Cloud Wine/Malt-One Day Liquor License $75.00 � Town of North Andover,MA Total Fees $75.00 Payments Date Method Note Amount Aug.6,2018 Cash Board of Selectmen to waive the fee $75.00 NUA li Armen Jeknavorian Aug 6th 2018,11:56am On behalf of the Church, I'm asking the BOS to waive the fee, as in the past, since we are a non profit organization. Thank you, Armen https://northandoverma.viewpointcloud.io/#/explore/records/37742/98603 2/2 TOWN OF NORTH ANDOVER OFFICE OF TOWN CLERK 120 MAIN STREET NORTH ANDOVER,MASSACHUSETTS 01845 00RT#j Joyce A.Bradshaw,C 0 Telephone(978)688-9501 Town Clerk, FAX(978)688-9557 sSACHUS MEMORANDUM TO: Chris Nobile, Chairman, Licensing Commission Members of the Board of Selectmen Andrew Maylor, Town Manager FROM: Suzanne M. Pelich, Asst. Town Clerk DATE: August 13, 2018 SUBJECT: Change of Manager- The Stevens Estate at Osgood Hill Attached please find an application.for a Change of Manager at The Stevens Estate at Osgood Hill from Gail Lull to Victoria Otis. Included is a favorable recommendation from the Police Department. Please do not hesitate to contact me if you have any questions or concerns. Thank you. _ The Commonwealth of Massachusetts Alcoholic Beverages Control Commission 239 Causeway Street Boston,MA 02114 www.mass.gov/abcc AMENDEMENT APPLICATION FOR A CHANGE OF MANAGER Please complete this entire application, leaving no fields blank. If field does not apply to your situation, please write N/A. 1. NAME OF LICENSEE (Business Contact) ITown of North Andover DBA The Stevens Estate at Osgood Hill ABCC License Number �eaoSS-�r/�a City/Town of Licensee North Anclove:r:::�� 2. APPLICATION CONTACT The application contact is required and is the person who will be contacted with any questions regarding this application. First Name: Joanna 7 Middle: Louise Last Name: Ouellette Title: lAuthorized Representative Primary Phone: 9786827072 Email: Joanna@stevensestate.com 3. BUSINESS CONTACT Please complete this section ONLY if there are changes to the Licensee phone number, business address (corporate headquarters),or mailing address. Entity Name: 1 71 Primary Phone: Fax Number: Alternative Phone: Email: Business Address(Corporate Headquarters) Street Number: 23 ~1 Street Name: Osgood Street City/Town: North Andover State: MA Zip Code: 01845 Country: USA Mailing Address OX Check here if yourMailing Address is the some as your Business Address Street Number: Street Name: City/Town: State: Zip Code: Country: 1 APPLICATION FOR A NEW RETAIL ALCOHOLIC BEVERAGES LICENSE 4. MANAGER CONTACT The Manager Contact is required and is the individual who will have day-to-day,operational control over the liquor license. Salutation Ms First Name ictoria Middle Name �� Last Name Otis Suffix Social Security Number Date of Birth Primary Phone: c Email: ictoria@stevensestate.com Mobile Phone: Place of Employment IThe Stevens Estate at Osgood Hill Alternative Phone: Fax Number 978 682 6660 Citizenship/Residency[Background Information of Proposed Manager Are you a U.S.Citizen? (:Yes (' No Do you have direct,indirect,or financial interest in this license? ('Yes (: No Have you ever been convicted of a state, ('Yes (: No federal,or military crime? If yes,percentage of interest It yes it tach do affidavit that lists your convictions with an explanation for each If yes,please indicate type of Interest(checkau thatapply): Have you ever been Manager of Record of a { Yes (: No ❑ Officer ❑ Sole Proprietor license to sell alcoholic beverages? ❑ Stockholder ❑ LLC Manager If yes,please list the licenses ❑ LLC Member ❑ Director for which you are the current ❑ Partner ❑ Landlord or proposed manager: ❑X Contractual ❑ Revenue Sharing ❑ Management Agreement ❑ Other Please indicate how many hours per week you intend to be on the licensed premises 37.5 Employment Information of Proposed Manager Please provide your employment history for the past 10 years Date(s) Position Employer Address Phone ! 1 _I ,— Z C ' 4 d '7 �.� " Prior Disciplinary Action of Proposed Manager Have you ever been involved directly or indirectly in an alcoholic beverages license that was subject to disciplinary action? If yes, please complete the following: Date of Action Name of License State City Reason for suspension,revocation or cancellation ROPOSED:MANAGER.MUST COMPL'E TE A UORI RECUUEST FORM 2 ADDITIONAL SPACE The following space is for any additional information you wish to supply or to clarify an answer you supplied in the application. If referrencing the application,please be sure to include the number of the question to which you are referring. APPLICANT'S STATEMENT I, the: ❑sole proprietor; ❑ partner; 0 corporate principal; ❑ LLC/LLP member orized signatory of he Stevens Estate at Osgood Hill , hereby submit this application for JGhange of License/Manager Name of the Entity/Corporation Transaction(s)you are applying for (hereinafter the"Application"),to the local licensing authority(the"LLA")and the Alcoholic Beverages Control Commission (the "ABCC" and together with the LLA collectively the"Licensing Authorities")for approval. I do hereby declare under the pains and penalties of perjury that I have personal knowledge of the information submitted in the Application, and as such affirm that all statement and representations therein are true to the best of my knowledge and belief. I further submit the following to be true and accurate: (1) 1 understand that each representation in this Application is material to the Licensing Authorities' decision on the Application and that the Licensing Authorities will rely on each and every answer in the Application and accompanying documents in reaching its decision; (2) 1 state that the location and description of the proposed licensed premises does not violate any requirement of the ABCC or other state law or local ordinances; (3) 1 understand that while the Application is pending,I must notify the Licensing Authorities of any change in the information submitted therein. I understand that failure to give such notice to the Licensing Authorities may result in disapproval of the Application; (4) 1 understand that upon approval of the Application, I must notify the Licensing Authorities of any change in the Application information as approved by the Licensing Authorities. I understand that failure to give such notice to the Licensing Authorities may result in sanctions including revocation of any license for which this Application is submitted; (5) I understand that the licensee will be bound by the statements and representations made in the Application, including, but not limited to the identity of persons with an ownership or financial interest in the license; (6) 1 understand that all statements and representations made become conditions of the license; (7) 1 understand that any physical alterations to or changes to the size of,the area used for the sale, delivery,storage, or consumption of alcoholic beverages, must be reported to the Licensing Authorities and may require the prior approval of the Licensing Authorities; (8) 1 understand that the licensee's failure to operate the licensed premises in accordance with the statements and representations made in the Application may result in sanctions, including the revocation of any license for which the Application was submitted;and (9) 1 understand that any false statement or misrepresentation will constitute cause for disapproval of the Application or sanctions including revocation of any license for which this Application is submitted. I , Signature: M14Date: t Title: Director THE STEVENS ESTATE JL L,25,.2,012 Of MOSSUC`lU:5,3tts antna com-niss' B-3 s-c i I A C'I I I i e Gourd V':D te—Tisa S t c ve n s E 5 t a t c.L[quer c n. o 11 R,4<3v T his;s lc certitv thal.at tho rwi;--v m.,eelirg of I�e Stevens Esute Boara Cf Trusir:'as, at 111c kx-,4ti�,d at f,'�3 Osgood stree-, Norn;",An*','Iov,.-r MA CV—SAI-7, al! Iret.p 'ia 7:i m:D u sl*-,,voted f or Vi ctor'-Z 0"'I'S:oarG,11 I I Ll 1. 1 a I f.(.i r- .1 . anc Holder of v,c uor 7 E, ';e 7 P b,', - r. -:-ka xrn.-,r al T'qC-C%cia: r;f 1 r 7/6/2018 eTIPS On Premise 3.0 a, ��. °rWr /a'�a.oa BA o 4 °!�Y ° a 'r r � 7- . r a5 tip ca ... °e Wyy°! r •! a � 7 p' �°' W r a+rr5rre iir.ra Y rW/Bt Y n all a of it { ® u it rW l Iq r e 1'r rl«�! Y rA W r r rtAa e e ab a♦♦ {e rl®e'eS t. _s+,}W allr W<IB4AI W#elryr el a}E WI!}�1 WII Ai t AI f P f F eM1 di Y br Y ul W W� t�A�Ifi AA A ra W r l l M4A AtA A1;,�. e r t I" r a e of o m p r I This Certificate of Completion of '`` t '® eTIPS On Premise 3.0 $ P _ For coursework completed on July 6, 2018 `= provided by Health Communications,. Inc. = is hereby granted to: r\ Victoria Otis --" Certift cation to be sent to: m1 Stevens Estate, Town of North Andover q 723 Osgood St North Andover MA, 01845-1819 USA .r_® s )� HEAtti.butt:<ne q ' (NGil tt'Se�.liliu.eun Ets:rn:ai`..n,ie tLetr •uhte r.,tr: Yi]eJt'et wv S�iiJ.t:ttti�s.cenJueutsZetiLs Webe dod w ou. d— _ — � '�11r+r ®ii�®bF m6A4Aieia eee®e'q�® stir lie 8rd®!1'de'1 bY1;lf�9 1) ®B Y A�1�W Yf�A91 ,i A { 1 � }Jp �111k A�NA� `illii &fY 1� °bearr A �ff A a A Y ® Y I +r 1 a WA l41ba A A AamaY r a<,a ®apo«� la 1 i k V ab ma M1 ri a fYa Hr rr 1 ! r1 rr r HYa 6 ire 1®+B® 1 ra ar a i \�J`J.«r �� ti N fa a 4 a`R� //. .76 ♦i re�� I �i rs +ap a aW a Ir. J '.•\ rel c® e s b'q� � � q,, 5' w eti® �ti �� °•`..,,'�:•, t �eti s°':� ��d;,��„ .[tom` .k'ar {n r°� .�: `79�Y °�' ..�`;�e^:,; �,s•° "J�r �' � s � •r a. �. .,C_•.,�..� b,rr, .;_ .�'v r `m^ k'}r -,.8 .. �*r.r•�.m.,r7e-- °,r _ss?lt•°..c .+ ''C"i i "v76�,�'` _Ts,fir.. .� °{-..t•e°+ .., deme L J .O� �� ,,�,r��-✓`,%'�'� �j ` •"ti„r �v.,. �..: �,i✓''#`� ,i' y�.. ti.:� c �%J�n. ''„t�\Zv ✓r ••-•":°:.�. http://w1.certegrity.com/OpenCertificate.html?RID=2HEONGICHIOO&T[D=AS2011 BMFUF&UID=4Rl4DKB6Y4CZ&SES=S6161956WCQW&PP=PBS... 1/1 NORTH ANDOVER ---Community Partnership Operations Division Division Lieutenant Daniel P. Lanen i TO: Suzanne Pelich FROM: Lieutenant Daniel P. Lanen I RE: Stevens Estate F DATE: July 25, 2018 Please be advised that the following request for a Change of Manager has been reviewed. The Police Department has no issues with this change. Fingerprint and background checks have been conducted and no issues arose concerning the new manager,Victoria Otis. 1475 Osgood Street, orth Andover® Massachusetts 01845 Telephone:978-683-3168 Fax:978-681-1172 6 TOWN OF NORTH ANDOVER OFFICE OF TOWN CLERK 120 MAIN STREET NORTH ANDOVER,MASSACHUSETT'S 01845 NORTH Joyce A.Bradshaw,CMMC 'Telephone(978)688-9501 Town Clerk, FAX(978)688-9557 .4c"Us MEMORANDUM TO: Chris Nobile, Chairman, Licensing Commission Members of the Board of Selectmen Andrew Maylor, To Manager FROM: Suzanne M. Pelich, Asst. To Clerk DATE: August 13, 2018 SUBJECT: One Day Liquor License Requests Attached please find a one day wine and malt liquor license application from Paul Gallant, on behalf of Merrimack College. The event is to be held on August 3 0,2018 A favorable recommendation has been given from the Police Department, Fire Department and the Building Inspector with no conditions. Please do not hesitate to contact me if you have any questions or concerns. Thank you. 8/1/2018 Special One Day Liquor License 37681 Applicant Sj Merrimack College Attn Paul Gallant % 978-837-3523 ext. 3523 @ gallantp@merrimack.edu Location 315 TURNPIKE STREET NORTH ANDOVER, MA 01845 Event Information: Address of applicant: Type of organization: 315 Turnpike Street North Andover, MA 01845 Non Profit Location of Event Type of event: Stadium Pavilion Reception Date of event: Start time of event: 08/30/2018 6pm End time of event Type of alcohol served: 8pm Wine and Malt Is the event being catered? Name of caterer: Yes Sodexo Will there be use of a temporary tent? Will there be a generator used at the event? Yes No Will there be entertainment? No **ALCOHOL MUST BE PURCHASED BY THE LICENSEE FROM AN AUTHORIZED WHOLESALER** Has permission been received from the property owner Who is serving the alcohol? to hold this event? Sodexo Bartenders Yes Does the server have liquor liability insurance? Yes Do servers have TIPS certification? "*This is required. Yes 1/2 TOWN OF NORTH ANDOVER OFFICE OF TOWN CLERK 120 MAIN STREET NORTH ANDOVER., MASSACHUSETTS 01845 NORTH 11 SD Joyce A.Bradshaw,CMMC 10 'relephone(978)688-9501 Town Clerk, 41 FAX(978)688-9557 ACHUS MEMORANDUM TO: Chris Nobile, Chairman, Licensing Commission Members of the Board of Selectmen Andrew Maylor,Town Manager FROM: Suzanne M. Pelich, Asst. Town Clerk DATE: August 13, 2018 SUBJECT: One Day Liquor License Requests Attached please find six one day liquor license request from Deborah Ingalas of Butlers & Bars. The events are to be held at Smolak Farm under the tent on August 18'h, September 2°d, 9th, 15",200 and 22nd. A favorable recommendation has been given from the Police Department, Fire Department and the Building Inspector with no conditions. Please do not hesitate to contact me if you have any questions or concerns. Thank you. 7/16/2018 Special One Day Liquor License 37299 Applicant Deborah Ingalls �. 617-899-9865 ext. @ butlersandbars@msn.com Location 315 SOUTH BRADFORD STREET NORTH ANDOVER, MA 01845 Event Information: Address of applicant: Type of organization: Winnie Wiwatyukhan Individual Location of Event Type of event: Tent Wedding If this is a private function (ie wedding, birthday, Date of event: shower, etc)will there be an open bar? 08/18/2018 Yes Start time of event: 4pm End time of event Type of alcohol served: 10pm All Alcohol Is the event being catered? Name of caterer: Yes littleneck Will there be use of a temporary tent? Will there be a generator used at the event? Yes No Will there be entertainment? Yes **ALCOHOL MUST BE PURCHASED BY THE LICENSEE FROM AN AUTHORIZED WHOLESALER** Has permission been received from the property owner Who is serving the alcohol? to hold this event? Butlers & Bars Yes Does the server have liquor liability insurance? Yes 1/2 7/16/2018 Special One Day Liquor License 37307 Applicant Deborah Ingalls 617-899-9865 ext. @ butiersandbars@msn.com Location 315 SOUTH BRADFORD STREET NORTH ANDOVER, MA 01845 Event Information: Address of applicant: Type of organization: Jennifer Martin Individual Location of Event Type of event: Tent Wedding If this is a private function (ie wedding, birthday, Date of event: shower, etc)will there be an open bar? 09/02/2018 Yes Start time of event: 4:00 p.m. End time of event Type of alcohol served: 9:00 P.M. All Alcohol Is the event being catered? Name of caterer: Yes littleneck Will there be use of a temporary tent? Will there be a generator used at the event? Yes No Will there be entertainment? Yes **ALCOHOL MUST BE PURCHASED BY THE LICENSEE FROM AN AUTHORIZED WHOLESALER** Has permission been received from the property owner Who is serving the alcohol? to hold this event? Butlers & Bars Yes Does the server have liquor liability insurance? Yes 1/2 7/16/2018 Special One Day Liquor License 37308 Applicant Q Deborah Ingalls % 617-899-9865 ext. @ butlersandbars@msn.com Location 315 SOUTH BRADFORD STREET NORTH ANDOVER, MA 01845 Event Information: Address of applicant: Type of organization: Epizyme Individual Location of Event Type of event: Tent Corporate Family Picnic If this is a private function (ie wedding, birthday, Date of event: shower, etc)will there be an open bar? 09/09/2018 Yes Start time of event: 11:00 a.m. End time of event Type of alcohol served: 6:00 p.m. All Alcohol Is the event being catered? Name of caterer: Yes littleneck Will there be use of a temporary tent? Will there be a generator used at the event? Yes Yes Will there be entertainment? Yes **ALCOHOL MUST BE PURCHASED BY THE LICENSEE FROM AN AUTHORIZED WHOLESALER** Has permission been received from the property owner Who is serving the alcohol? to hold this event? butlers & bars Yes Does the server have liquor liability insurance? Yes 1/2 7/16/2018 Special One Day Liquor License 37298 Applicant Deborah Ingalls �. 617-899-9865 ext. @ butiersandbars@msn.com Location 315 SOUTH BRADFORD STREET NORTH ANDOVER, MA 01845 Event Information: Address of applicant: Type of organization: Martin Cohen Individual Location of Event Type of event: Tent Wedding If this is a private function (ie wedding, birthday, Date of event: shower, etc)will there be an open bar? 09/15/2018 Yes Start time of event: 4:00 p.m. End time of event Type of alcohol served: 10:00 P.M. All Alcohol Is the event being catered? Name of caterer: Yes Littleneck Clambake Will there be use of a temporary tent? Will there be a generator used at the event? Yes No Will there be entertainment? Yes **ALCOHOL MUST BE PURCHASED BY THE LICENSEE FROM AN AUTHORIZED WHOLESALER" Has permission been received from the property owner Who is serving the alcohol? to hold this event? Butlers & Bars Yes Does the server have liquor liability insurance? Yes 1/2 7/16/2018 Special One Day Liquor License 37309 Applicant ,Qt Deborah Ingalls % 617-899-9865 ext. @ butlersandbars@msn.com Location 315 SOUTH BRADFORD STREET NORTH ANDOVER, MA 01845 Event Information: Address of applicant: Type of organization: The Crosby Company 11 Keewaydin Drive Salem, NH Individual 03079 Location of Event tent Type of event: If this is a private function (ie wedding, birthday, shower, etc)will there be an open bar? corporate dinner Yes Date of event: Start time of event: 09/20/2018 4:00 p.m. End time of event Type of alcohol served: 9:00 P.M. Wine and Malt Is the event being catered? Name of caterer: Yes littleneck Will there be use of a temporary tent? Will there be a generator used at the event? Yes No Will there be entertainment? Yes **ALCOHOL MUST BE PURCHASED BY THE LICENSEE FROM AN AUTHORIZED WHOLESALER** Has permission been received from the property owner Who is serving the alcohol? to hold this event? butlers & bars Yes Does the server have liquor liability insurance? 1/2 7/19/2018 Special One Day Liquor License 37397 Applicant A Deborah Ingalls % 617-899-9865 ext. @ butlersandbars@msn.com Location 315 SOUTH BRADFORD STREET NORTH ANDOVER, MA 01845 Event Information: Address of applicant: Type of organization: 3 Sherman Streeet, Brooklyn, NY 11215 Individual Location of Event Type of event: Tent Wedding If this is a private function (ie wedding, birthday, Date of event: shower, etc)will there be an open bar? 09/22/2018 Yes Start time of event: 4pm End time of event Type of alcohol served: 10:00 p.m All Alcohol Is the event being catered? Name of caterer: Yes Littleneck Will there be use of a temporary tent? Will there be a generator used at the event? Yes No Will there be entertainment? Yes **ALCOHOL MUST BE PURCHASED BY THE LICENSEE FROM AN AUTHORIZED WHOLESALER** Has permission been received from the property owner Who is serving the alcohol? to hold this event? Butlers & Bars Yes Does the server have liquor liability insurance? Yes 1/2 TOWN OF NORTH ANDOVER Telephone:978-688-9501 LICENSING COMMISSION Fax 978-688-9557 120 MAIN STREET NORTH ANDOVER, MA 01845 LICENSING FEES ALCOHOLIC BEVERAGES TOWN FEE APPLICATION FEE $100.00 RESTAURANT-ALL ALCOHOL $3,000.00 RESTAURANT-WINE &MALT $2,000.00 CLUB-ALL ALCOHOL $2,000.00 FARMER-SERIES POURING PERMIT $1,500.00 PACKAGE STORE-ALL ALCOHOL $2,000.00 PACKAGE STORE-WINE &MALT $1,500.00 ONE DAY-ALL ALCOHOL $100.00 ONE DAY-WINE &MALT $75.00 OTHER LICENSES ONE DAY-ENTERTAINMENT $100.00 COMMON VICTUALLER $75.00 ENTERTAINMENT $100.00 AUTOMATIC AMUSEMENT $100.00 per device CLASS 11 & III $100.00 LIVERY $250.00 per car FORTUNE TELLER $50.00 MOBILE FOOD TRUCK no fee M A ffi INTEROFFICE MEMORANDUM DATE: August 8, 2018 J A 1 TO: Andrew W. Maylor, Town Manager FROM: Jim Stanford, Director of DPW CC: Susanne Egan, Town Counsel John Borgesi, Town Engineer IRC: Temporary Easements for MassDOT Mass Avenue - Chicl(ering Road Intersection Fro,ject n As part of the MassDOT Massachusetts Avenue & Chickering Road Intersection Project, there are two (2) right of entries/temporary easements and one (1) land damage agreement/temporary easement on Town owned property that are required to be execrated by the Board of Selectmen in order for the project to move forward. Attached are copies of the right of entry and land damage documents including site sketches. All of these documents have been reviewed and approved by Towyn Counsel. If you should have any questions, please do not hesitate to contact me. i1 i -4ee 7HighwayDiiivision c OT Ri ht of Entry Y assachusetts Departdment of Transportation City/ MASS AVE AT CHICKERING RD. Town: North Andover Project: RTS 125/133 Project# 606159 Owner: TOWN OF NORTH ANDOVER City/Town, Address: 120 Main St. state,zip North Andover, MA 01845 From To Station: 172 Station: 175 Parcel No(s): 16-TE-23 & 16-TE-35 Permission is hereby given to the Massachusetts Department of Transportation-Highway Division, or its duly authorized agents, to enter upon my property in the city or town of North Andover in connection with the construction of a state highway as shown on plans in the office of said Department at 10 Park Plaza, Boston, Massachusetts for the purpose of making changes and carrying out the work on my property as outlined below: This entry is to be made without prejudice to my rights in settlement of any claims for damage that may hereafter appear. Granted by: Recommended by: Signature of Owner Deputy Director, Right of Way Bureau Date: Date: Form revised 01/2016 ROW Form 681 v .� , �o PARCEL 16-TE-23, 6 'P�WN OF hJ'ORifH ANDOVER AREA 37 S.E.± r CLEAN O�6T EXISTING DRAINAGE OUTFALL � W 17' END SW +80 RET. GB SOP T TO SCALE proposed Highway Layout Lime: '' J .: 606159 NORTHANDOVER E TOWN OF Exisfing Kghway Layout Une- NORTHANDOVER 'AR SKETCH Property Luny: ,mt (f06 hh h CLEAR AND GRUB. CREATE DITCH TO ALLOWWATER TO FLOW PARCEL 16-TE-35 TOWN OF NORTH ANDOVER AREA 1,657" S.FA CLEAN OUT EXIST DRAINAGE OUTFALL • yr r 9 ©M4- i�ww�ww w��ww��ww��ww��ww��ww��ww��ww��ww��ww��ww��ww��ww��ww��ww��ww��ww��ww��ww��ww��w 1931 S. B.L. ... ..... REE ,[. iVB ��wrrrrrr� wrrr� ;� r� wwwwwrr► ..rrrirr�w�n �wwrrrr�.... r��wwwrw wrrrr�. �rw�� CONSTR JCTION BASELINE 172 PROP. 'RAN, CURB TYPE ' B SAW�PCUT RET, PROPOSED - NOT TO SCALE proposed Highway Layout Lime: RR .: 60,6159 Exisfing Kghway Layout Lune- T - ANDOVER - TOWN OF NORTHANDOVER Property Lune: PARCEL SKETCH -4ee 7HighwayDiiivision c OT Ri ht of Entry Y assachusetts Departdment of Transportation City/ MASS AVE AT CHICKERING RD. Town: North Andover Project: RTS 125/133 Project# 606159 Owner: TOWN OF NORTH ANDOVER City/Town, Address: 120 Main St. state,zip North Andover, MA 01845 From To Station: 268 +50 Station: 269 + 5 Parcel No(s): 16-TE-31 & 16-TE-34 Permission is hereby given to the Massachusetts Department of Transportation-Highway Division, or its duly authorized agents, to enter upon my property in the city or town of North Andover in connection with the construction of a state highway as shown on plans in the office of said Department at 10 Park Plaza, Boston, Massachusetts for the purpose of making changes and carrying out the work on my property as outlined below: Utility and Drainage construction This entry is to be made without prejudice to my rights in settlement of any claims for damage that may hereafter appear. Granted by: Recommended by: Signature of Owner Deputy Director, Right of Way Bureau Date: Date: Form revised 01/2016 ROW Form 681 CLEAR AND GRUB EXISTING DITCH TO ALLOW WATER TO FLOW PARCEL 16-D-11_x' ......... TOWN OF NORTH ANDOVER AREA 357 S.F'.+ (BEE DETAIL SKETCH) PARCEL 18-D-P'UE-4-T TON OF NSD] H ANDOVER AREA 15 S.F.± (SEE DETAIL BKETCH) 20"! RET PROP, f FILTEF RET RET CL TE'-�34 CLIA PARCEL 1�- RET. TI v TOWN OF NORTH � a RENT, ANDOVER ANDCM ` ^ RSR T, AREA 493 S.F..± —8 ROW L 872'1 awl"'W C U T mmmmmmm mm RET. CB 33':x. 18' KR—C i - E-31 — TOWN OF ORTH ANDOVER AREA 4 S.F.+ PROPOSED - NOT TO CA,L R O o.: 60,6159 NORTHANDOVER - TOWN OF Proposed Highway Layout Lime: NORTHANDOVER PARCEL SKETCH Exisfing Rghway Layout Lune: Pro rty Lune: � � �4e ' OT Land Damage Massachusetts Department of Transportation Agreement Highway Division ir Standard Form City/Town: North Andover Project: MASS AVE AT CHICKERING RD. RTS 125/1 Project#: 606159 Owner: TOWN OF NORTH ANDOVER City/Town, Mailing Address: 120 Main St. State,Zip North Andover, MA 01845 County : Northern Essex Layout#/Order: 8607 Parcel No(s): 16-D-11-T& 16-D-PUE-4-T FAP#(ROW): NFA This agreement is entered into for full settlement of any and all claims for damage incurred or to be incurred by the Massachusetts Department of Transportation-Highway Division as a result of a taking by eminent domain, construction, and/or alteration relating to the subject property by the Massachusetts Department of Transportation-Highway Division. The land and/or rights in land taken and limitations of access, if any, are described in an order of taking (together with any related plans) adopted by the Massachusetts Department of Transportation-Highway Division, and on file at the office of said Department and to be recorded at the Registry of Deeds in the above referenced county. The owner agrees to accept the sum of$Zero in full settlement of any and all claims whatsoever to the taken or remaining property of the owner, whether caused by the taking of land and/or rights in land, limitations of access, changes in grade or drainage and/or alteration relating to the subject property; and hereby releases the Massachusetts Department of Transportation-Highway Division, from any and all claims, due to said taking, construction and/or alteration relating to the subject property. Additions to this agreement are as follows (if none, write"None") It is understood and agreed that this agreement shall become binding only when signed by the owner(s) and formally approved by the Massachusetts Department of Transportation-Highway Division Administrator. It is also understood and agreed that the owners are entitled to damages for the rights being acquired, but have agreed to accept no award of damages. The owner(s) agree(s)to indemnify and hold harmless the Massachusetts Department of Transportation-Highway Division with respect to any claims brought by any person or entity that may have an interest in the property, including but not limited to, any mortgagee, tenant(s)/subtenant(s) as a result of the taking(s)covered by this Agreement. Signature(s) of Owner(s): Date: Approved by: Deputy Director, Right of Way Bureau CLEAR AND GRUB EXISTING DITCH TO ALLOW WATER TO FLOW PARCEL 16-D-11_x' ......... TOWN OF NORTH ANDOVER AREA 357 S.F'.+ (BEE DETAIL SKETCH) PARCEL 18-D-P'UE-4-T TON OF NSD] H ANDOVER AREA 15 S.F.± (SEE DETAIL BKETCH) 20"! RET PROP, f FILTEF RET RET CL TE'-�34 CLIA PARCEL 1�- RET. TI v TOWN OF NORTH � a RENT, ANDOVER ANDCM ` ^ RSR T, AREA 493 S.F..± —8 ROW L 872'1 awl"'W C U T mmmmmmm mm RET. CB 33':x. 18' KR—C i - E-31 — TOWN OF ORTH ANDOVER AREA 4 S.F.+ PROPOSED - NOT TO CA,L R O o.: 60,6159 NORTHANDOVER - TOWN OF Proposed Highway Layout Lime: NORTHANDOVER PARCEL SKETCH Exisfing Rghway Layout Lune: Pro rty Lune: � � INTEROFFICE MEMORANDUM DATE; August 8, 2018 TO Andrew W. Maylor, Town Manager FROM; Jim Stanford, Director of DPW CSC; Ray Santilli,Assistant Town Manager Tien Willett, Operations Manager John Borgesi, Town Engineer RE; Request to Surplus 'Vehicles and Equipment I am requesting that the Board of Selectmen surplus the following equipment that has been determined by DPW Mechanics to be beyond their useful life and will be traded in on new equipment shortly. Year Manufacture Vin # Vehicle # Mileage/Hours & Model 1992 Chev - Topkick 1GBP7H1J9PJ102888 31 68709 miles 2004 Ghee)(_- 2500 1GCHK24U74E30180245 87815 mikes 200:5 Chevy - 2500 1GCHK24U25E315348 _ 5 12.6232 miles 2009 Chevy - 3500 1 GBJC74KX9F1.590018 43 67065 miles 2000 JCB - BackhoeSILP215FCYE0495724 62 - D na ac - Koller 81034 Roller - No odometer if you should have any questions, please do not hesitate to contact me, May 11, 2118 Office of the Govemor ChiefCommonwealth o�f Massachusetts State House Boston, Massachusetts 02133 Tel: (h 1.7) 725-4000 CHARLES D. BAKER KARYN E. Governor POLITO Lieutenant Governor William McCarthy North Andover Fire Department 795 Chickering Road North Andover, MA 01845 Hear Chief McCarthy: The Executive Office of Public Safety and Security, Office of Grants and Research-Highway Safety Division (EOPSS/OGR/HSD) is pleased to support the traffic safety efforts of your department with a FFY 2018 Child passenger Safety(CPS) Equipment Grant award. based on the federal funding to support this award from the National Highway Traffic Safety Administration, your award amount is $2,625.00. Your contact for this grant is John Fabiano, Highway Safety Division Program Coordinator,. Enclosed is a copy of the car seat order form and product price list. Please submit your order via email to iohn.fabianoLbstate.ma.us by friday, May 251" 'e`v'e thank you for the work you do to keep children safe on out,roads. Sincerely, C" k"_0 Governor Charles D. baker Lt. Governor Katyn E. Polito North Andover Fire rtments Proudly Present ChildBack To, School I hVii ilyr?,VM' riI�r�ei ryru V i urda Au ust 18 2018 sat � , y 10:OOAM - 1:OOPM J North Andover Fire Department 795 Chickering toad North Andover, MA 01845 i fr � jr Notionally Certified Child Passenger Safety Technicians Will Help You With w+t f i rw '"w .... ,dw+dwrtwsdre g'r 'wty'.,"w. r V • Proper car seat installation " • The correct car seat for your child's weight and age t • Check your restraint for safety recalls r AGENDA COVER MEMORANDUM To: Board of Selectmen Thru: Andrew W. Maylor From: Laurie Burzlaff, Executive Assistant Date: July 23, 2018 Re: Walk for the Poor Request from: The Saint Vincent de Paul Conference Approve for: Use of the Town Common on Saturday,September 22, 2018 from 10:OOAM-12:OOPM for the Walk for the Poor Reviewed by: Police Department Notes: No conditions Fire Department Notes: No conditions Public Works Notes: Applicant to remove any trash generated by their event at their tables. Use of Town Common Permit 37377 Applicant R Joseph Contrada % 9782694292 @ contradarealestate@comcast.net Location 0 NORTH ANDOVER TOWN COMMON NORTH ANDOVER, MA 01845 General Information Name of North Andover group or individual applying Is the purpose of the use of the Town Common for the for use of the Town Common: public display of art, banners, signs and symbols? Saint Vincent de Paul Conference of St Michael Church No Is the purpose of the use of the Town Common to conduct an event where more than twenty people may assemble and/or participate? Yes Date(s) and Time(s) Requested: Time(s): (i.e. 11:OOAM -5:OO13M) Date: 10:OOAM - 12:00 PA 09/22/2018 Use of the Town Common for the Purpose of Conducting an Event Please describe the nature and purpose of the event: A Walk around the Common for the benefit of the poor and otherwise disadvantaged in North Andover. In total, how many individuals do you anticipate At any one time during the event, what is the maximum attending the event? number of people expected to be on the common? -- 50 Who will be the person or persons representing the applicant who will be present throughout the event? If these persons will be taking shifts, please provide the time of their shifts: Joseph G. Contrada Will you be erecting any temporary structures on the Will you need access to electricity for this event? common such as tents, fences, athletic equipment? No Will you be serving any food or beverages during the event? No Will you be charging a fee for any services provided such as food, beverages, games, races, etc.? Please make sure to attach a fee schedule in the uploads section. No Please describe where vehicles of participants in the event will park: Wherever legally available Please describe what your clean up plans consist of in terms of number of people assisting in the clean up, how trash will be removed from the common and disposed, etc: SVdP Conference members will remove all signs, tables and chairs immediately after conclusion of the walk Acknowledgements and Signatures The signer is duly authorized to sign the application on The user of the common will comply with all rules, behalf of the applicant and is a resident of North regulations and conditions applicable to the use of the Andover or works for a non-profit organization whose common. principal place of business is located in North Andover. true true The user of the common will hold the Town, its employees and agents harmless from any and all claims, suits, causes of action,judgments and demands of any nature made or obtained by third parties which result from activities or actions of the Town of North Andover, its agents or servants under this permit and if the judgment is entered against the Town of North Andover, said judgment will be paid by said applicant together with all interest thereon. true Conditions 1+1 D � AGENDA COVER MEMORANDUM To: Board of Selectmen Thru: Andrew W. Maylor From: Laurie Burzlaff, Executive Assistant Date: August 8,2018 Re: Appointments The appointment subcommittee is recommending the following appointments: Christopher lee-Affordable Housing Trust Justin Lafond- Neighborhood Conservation District Commission Michael Lis-Zoning Board of Appeals(associate member) Steve Seide-Zoning Board of Appeals(associate member) Patricia Riley-Council on Aging Jenna Sideri-Youth & Recreation Council William Swiggart-Stevens Estate Advisory Committee Derrick Ward-Sustainability Committee Martha Wolfenden- Historical Commission North Andover, MA 120 Main Street Phone:978-688-9500 Volunteer Form Good Government Starts with You Date Submitted: July 16,2018 Name: Christopher Jee Home Address: 154B High Street NORTH ANDOVER Mailing Address: 154B High Street NORTH ANDOVER Phone Number(s): Email Address Current Occupation/Employer: Attorney/Mass. Dept.of Housing and Community Development Narrative: As an attorney with experience in affordable housing development and preservation,I am very interested in joining the town's affordable housing trust.With my experience,I am very familiar with the processes involving the creation of and(re)sales of affordable homes in various affordable housing programs.I am generally available weekday evenings and can periodically make myself available during late afternoons. Board(s)/Committee(s): AFFORDABLE HOUSING TRUST Page 1/1 .a North Andover, MA 120 Main Street Phone: 978-688-9500 Volunteer Form Good Government Starts with You Date Submitted: July 6,2018 Name: Justin Lafond Home Address: 35 Bixby Street North Andover Mailing Address: 35 Bixby Street North Andover Phone Number(s): i_ -Unspecified Email Address: Current Occupation/Employer: R.C. Lafond insurance Agency Narrative: I would be available Monday-Friday,9am to 9pm. Weekends are available as long as scheduled in advance. I do not have experience with this type of service,but work at a local family business. I grew up in North Andover and have been involved in soccer,Boy Scouts,and many other town programs. I currently live in Machine Shop Village and am interesting in the Neighborhood Conservation Commission. Board(s)/Committee(s): _NEIGHBORHOOD CONSERVATION DISTRICT COMM. Page 1/1 North Andover, MA 120 Main Street Phone:978-688-9500 Volunteer Form Good Government Starts with You Date Submitted: July 5,2018 Name: Michael TW Lis Home Address: 30 Leanne Dr. NORTH ANDOVER,MA 01845 Mailing Address: 30 Leanne Dr. NORTH ANDOVER,MA 01845 Phone Number(s): Email Address: Current Occupation/Employer: Senior Chemist,Viridis3D Narrative: I'm a husband,father of two,and PhD scientist. I care deeply about expanding the availability of housing options in North Andover,especially for those at the lower end of the income spectrum. Board(s)/Committee(s): _AFFORDABLE HOUSING TRUST ZCANNING BOARD ONING BOARD OF APPEALS Page 1/1 .°N. North Andover, MA 120 Main Street Phone:978-688-9500 Volunteer Form Good Government Starts with You Date Submitted: July 6,2018 Name: Steve R Seide Home Address: 25 Great Lake Lane North Andover Mailing Address: 25 Great Lake Lane North Andover Phone Number(s): Email Address: Current Occupation/Employer: Self employed Narrative: Commitment appears to be—1-2 times monthly which should be workable. Bachelor of Science degree-currently an Independent Consultant,Formerly,CEO of Avancen MOD Corporation,a medical device company. Previously,National Vice President,Cardinal Health a Fortune 19 company. My skills are diverse with roles as a manufacturer and distributor.Management,operations,sales and general management. Board(s)/Committee(s): _AFFORDABLE HOUSING TRUST _SUSTAINABILITY COMMITTEE VGONING BOARD OF APPEALS Page 1/1 � r North Andover, MA 120 Main Street Phone:979-688-9500 Volunteer Form Good Government Starts with You Date Submitted: July 11,2018 Name: Patricia Riley Home Address: 36 Sawyer Road No.Andover Mailing Address: 36 Sawyer Road No.Andover Phone Number(s) Email Address: Current Occupation/Employer: Retired Narrative: Have attended TRIAD meetings,helped with Outreach Program and the Tax Incentive Program. Board(s)/Committee(s): _COUNCIL ON AGING Page 1/1 North Andover, MA 120 Main Street Phone:978-688-9500 Volunteer Form Good Government Starts with You Date Submitted: June 5,2018 Name: jenna m sideri Home Address: 55 moody st north andover Mailing Address: 55 moody st north andover Phone Number(s): Email Address: Current Occupation/Employer: teacher on extended maternity leave Narrative: I am currently home with my two daughters,so have more"free"time than I will when I am back at work.I am available to attend the committee meetings and help in other advisory capacities. My background is in Social Work/Education.I have a B.A.from Providence College(where I worked as a social worker in schools,worked for the DCYF,and focused my thesis studies on the development of anxiety and depression in students). My Masters degree is in Elementary Education(I worked teaching elementary students in Lawrence for over a decade). I am currently adding on a degree in ESL. Additionally,I worked at the Youth Center for most of my teen/early twenties and I have two children who will be utilizing these services in the coming years. Board(s)/Committee(s): _YOUTH&RECREATION COUNCIL Page 1/1 North Andover, MA 120 Main Street Phone:978-688-9500 Volunteer Form Good Government Starts with You Date Submitted: July 3,2018 Name: William F Swiggart Home Address: 270 So.Bradford Street North Andover Mailing Address: 270 So.Bradford Street North Andover Phone Number(s): Email Address: Current Occupation/Employer: Swiggart&Agin,LLC Narrative: I serve in a fiduciary capacity in my roles as attorney and as Manager of Beacon Angels. I am an avid hiker and regularly walk the trails of Stevens Estate and have some ideas about how better to sustain them. Board(s)/Committee(s): STEVENS ESTATE ADVISORY COMMITTEE Page 1/1 North Andover, MA 120 Main Street Phone:978-688-9500 Volunteer Form Good Government Starts with You Date I May 28,2018 Name: Derrick Ward Home Address: 45 Royal Crest Drive,Apt.5 NORTH ANDOVER,MA 01845 Mailing Address: 45 Royal Crest Drive,Apt.5 NORTH ANDOVER,MA 01845 Phone Number(s): ....... Email Address: Current Occupation/Employer: ProgramManager/Beyond Benign Narrative: Dear City of North Andover, My name is Derrick Ward.I formally wanted to express my interest in volunteering my time on the Sustainability Committee for the City of North Andover.This opportunity appeals to my strong interests in giving back to the community that best aligns with my skills,all while, pursuing my intrinsic philanthropic goals of putting the needs others before myself.As a volunteer on the Sustainability Committee,I will be able to apply my Sustainability and Green Chemistry knowledge to real world situations while working with community members to disseminate practical solution for the community. From an education standpoint,I have a masters degree in Green Chemistry.Green Chemistry is the science and innovation behind Sustainability.Professionally,have been exposed to a broad a range of Sustainablity topics with a strong emphasis in applying the disciplines of Green Chemistry.My experiences have allowed me to look at the current practices and think of new opportunities that will provide novel,safe,and cost effective solutions.These skills,coupled with my continual knowledge in Sustainability,I believe would make me an integral member to the committee and provide constructive contributions to make the World a better place. At my current role at Beyond Benign,I am responsible for managing programs that practice Sustainability through chemistry education.So along with my industrial experience,my new skills allow me to educate higher education students and working professionals on the innovative capability of Green Chemistry to help catalyze sustainability initiatives in business operations. As a resident of the North Andover community,I am open and flexible with meeting times for the Sustainability Committee.I am available everyday of the week after standard work hours (9-5pm)whenever needed.Also,I am committed to work on weekends to help the committee develop and successfully implement ideas and programs in the North Andover community. If you have any questions,please give me a call at 513-479-5053 or e-mail me at reen.0 emist023@ mail.co ,Thank you for your consideration and I look forward to hearing from you soon! All the Best, Page 112 North Andover, MA 120 Main Street Phone:978-688-9500 Volunteer Form Good Government Starts with You Date Submitted: July 15,2018 Name: Martha F Wolfenden Home Address: 92 Putnam Road North Andover Mailing Address: 92 Putnam Road North Andover Phone Number(s): Email Address: Current Occupation/Employer: Teacher(Grade 5)Franklin School,North Andover Public Schools,North Andover,MA Narrative: I would have roughly two hours/week available during the school year,and more during the summer. I have worked with Carol Majahad concerning school based activities and I completed the course offered by the Historical Society on the history of North Andover taught by Carol. I have an extreme interest in our town and its significant place in the history of early America. I am currently pursuing a DAR membership certificate for my family after many hours of genealogical research. Lastly,I am fortunate enough to live in a fairly historically significant house here in North Andover-the Mifflin Estate,originally occupied by George Putnam and family who owned the Pemberton Mills in Lawrence during the 1850's right before it burned down killing 90+mill workers in January of 1860. Board(s)/Committee(s): HISTORICAL COMMISSION Page 1/1 w AGENDA COVER MEMORANDUM To: Board of Selectmen Thru: Andrew W. Maylor From: Laurie Burzlaff, Executive Assistant Date: August 2, 2018 Re: LED Streetlight grant The Town has been awarded a grant in the amount of$173,783 from the Department of Energy Resources to be used to convert all the town owned street lights to LED lighting.The Board is being asked to accept this grant. Installation of the new streetlights will be complete by the end of the year. COMMONWEALTH:',ALTH OF MASSACHUSE11TS EXECUTIVE C"li7 IVE OFFICE OF ENEIRGY AN1) ;INVIRONMFNT AL AFFAIRS DEPARTMENT OF ENERGY RESOURCES 1.00 CAMBRIDGE ST., St FFE 1020 tICJS 1"ON, MA 02114 l'elephou- 617-626-71100 Facsimile: 617-727-0030 Charles ar°les D. Baker Matthew A.Reston Governor" Secretary Kar-yn E. Polito Judith F Judson I.t, Govemor Commissioner missioner- July 19, 2018 Andrew W. Maylor, Town Manager Town of North Andover 120 Main St North Andover, MA 01845 Dear Town Manager Maylor: I am pleased to inform you that the Department of Energy Resources (DOER) Green Communities Division has approved an award of$173,783 for the following projects proposed in the Town of North Andover's Green Communities Competitive Grant application. List of projects funded: • $173,783, Town-wide—LED streetlight conversion The Division reviewed North Andover's grant application and has determined these are viable projects that meet the eligibility requirements of our Competitive Grant program. Please note that, due to the competitive nature of this grant program, the use of these funds is restricted to the specifically- approved projects listed above. Jane Pfister, Green Communities Grant Coordinator, will follow up with the contact listed in your competitive grant application to discuss next steps, including coordination of the grant contract process. The Green Communities Division looks forward to working with the Town of North Andover on your grant projects. We congratulate you on your grant award, and applaud your efforts to create a cleaner energy future for your community and the Commonwealth as a whole. Please do not hesitate to contact meat 617-626-7358 or by email at Nichola. C:orangr�5r )MI it »y with any questions you may have regarding your grant award. The Commonwealth of Massachusetts tom: Executive Office of Energy and Environmental Affairs - Department of Energy Resources Governor Charles D. Baker Lt. Governor Karyn E Polito Green Communities Division Secretary Matthew A. Beaton Competitive Commissioner,Judith F. Judson Town of North Andover $ 173783 July 20, 2018 U11 , Date Massachusetts Judith Judson, Commissioner DEPARTMENT Of ENERGY WOUREEi North Andover, MA 120 Main Street Phone:978-688-9500 Volunteer Form Good Government Starts with You Date Submitted: July 5,2018 Name: Lori Crane Home Address: 87 Kara Drive NORTH ANDOVER,MA 01845 Mailing Address: 87 Kara Drive NORTH ANDOVER,MA 01845 Phone Number(s Email Address: CurrentOccupation/Employer: Principal Facility Planner,Sanofi Narrative: I am resident of North Andover for over 18 years.My career and professional experience is in Facility Planning and Management,Strategic Space Planning,Design,and Operations for over 25 years.I have experience in build-outs(large and small;laboratory and administrative). I am a member of the International Facility Management Association(IFMA). I am available 1-2 nights per month;2-3 hours,respectively. oar (s)/Committee(s): PLANNING BOARD Page 1/1 COMMONWEALTH OF MASSACHUSETTS WILLIAM FRANCIS GALVIN SECRETARY OF THE COMMONWEALTH WARRANT FOR 2018 STATE PRIMARY ESSEX SS. To the Constables of the TOWN OF NORTH ANDOVER GREETINGS: In the name of the Commonwealth,you are hereby required to notify and warn the inhabitants of said city or town who are qualified to vote in Primaries to vote at: ALL PRECINCTS(ONE TO EIGHT)1-8 NORTH ANDOVER HIGH SCHOOL 430 OSGOOD STREET NORTH ANDOVER,MA 01845 on TUESDAY,THE FOURTH DAY OF SEPTEMBER,2018, from 7:00 A.M.to 8:00 P.M.for the following purpose: To cast their votes in the State Primaries for the candidates of political parties for the following offices: SENATOR IN CONGRESS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FOR THIS COMMONWEALTH GOVERNOR. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .FOR THIS COMMONWEALTH LIEUTENANT GOVERNOR. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FOR THIS COMMONWEALTH ATTORNEY GENERAL. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FOR THIS COMMONWEALTH SECRETARY OF STATE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FOR THIS COMMONWEALTH TREASURER AND RECEIVER GENERAL . . . . . . . . . . . . . . . . . . . . . FOR THIS COMMONWEALTH AUDITOR. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FOR THIS COMMONWEALTH REPRESENTATIVE IN CONGRESS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . SIXTH DISTRICT COUNCILLOR. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FIFTH DISTRICT SENATOR IN GENERAL COURT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FIRST ESSEX DISTRICT SENATOR IN GENERAL COURT . . . . . . . . . . . . . . . . . . . FIRST ESSEX&MIDDLESEX DISTRICT REPRESENTATIVE IN GENERAL COURT. . . . . . . . . . . . . . . . FOURTEENTH ESSEX DISTRICT REPRESENTATIVE IN GENERAL COURT . . . . . . . . . . . . . . . . . . EIGHTEEN ESSEX DISTRICT DISTRICT ATTORNEY. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . EASTERN DISTRICT CLERK OF COURTS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ESSEX COUNTY REGISTER OF DEEDS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ESSEX NORTHERN DISTRICT Hereof fail not and make return of this warrant with your doings thereon at the time and place of said voting. Given under our hands this 13TH day of AUGUST,2018. Regina Kean, Chairman Phil DeCologero Chris Nobile Rosemary Connelly Smedile Richard M.Vaillancourt Selectmen of: North Andover And you are directed to serve this Warrant by posting true and attested copies thereof in the Town Office Building and one public place in each voting precinct in the Town, said copies to be posted not less than (7) seven days before the time of said election. Constable Date A True Copy Attest—Joyce A. Bradshaw, Town Clerk Pursuant to the foregoing warrant, I have warned and notified the inhabitants of the Town of North Andover who are qualified to vote in town affairs to be at the time and place for the purpose mentioned within by posting true and attested copies thereof at the town office building and one public place in each voting nrecinet in tht, Tnwn nt h net cnwo" dove hnf--- fh- A-1— --c--A � �= i rd AGENDA COVER MEMORANDUM To: Board of Selectmen T : Andrew W.Maylor From: Laurie Burzlaff,Executive Assistant Date: August 9,2018 Re: Permit fees for Town projects At your last meeting,there was a discussion about permit fees for municipal projects. I asked at that end of that session if the Board of Selectmen would agree to review and approve a master list of projects funded for the upcoming fiscal year. The idea was to simplify the process for those staff and contractors doing work on public buildings and spaces while maintaining the transparency with the public you were concerned about. The relevant department heads and division directors embraced this idea and with their assistance,we have produced the following spreadsheet. You will note that we have provided even more detail than we have historically requested when we requested one waiver at a time,thereby enhancing transparency. This report will be placed in the "Consent" section of the August 13th agenda. I respectfully request you approve a motion to "waive all fees associated with the projects found on the attached report". Thanks in advance for your support and consideration. TOWN OF NORTH ANDOVER FY19 PUBLIC PROJECT BUILDING PERMIT REPORT PROJECT DESCRIPTION PROJECT COST DEPARTMENT LIKELY PERMIT TYPE REMARKS Atkinson: interior renovations nurse/health area renovations S 10,000.00 School building unit ventilator replacement replace six(6)UV's at classrooms S 125,000.00 Facilities electrical,hvac roof preventative maintenance roof repairs at academic wing S 10,000.00 Facilities roof boiler boiler#2 replacement-also possibly second boiler S 60,000.00 Facilities gas,electric Kittredge: toilet room renovation replace urinals 2nd floor boys toilet $ 25,000.00 Facilities plumbing,electric,building,fire alarm,sprinkler basement renovations hallway partition at SPED,relocate library $ 15,000.00 School sprinkler,building, electric,sprinkler exterior cladding repairs replace window trim and flashing $ 5,000.00 School building Franklin: roof preventative maintenance roof repairs at academic wing $ 5,000.00 Facilities NAHS: hot water heater hot water boiler replacement $ 25,000.00 Facilities gas,electric hot water storage tanks replace two(2)hot water storage tanks $ 25,000.00 Facilities gas,electric,plumbing roof preventative maintenance roof repairs:fieldhouse,cupolas,tv studio $ 5,000.00 Facilities roof Library: fire alarm replace dated FACP $ 15,000.00 Facilities fire alarm,electrical front stairs structural repairs to historic front entry stairs $ 75,000.00 Facilities building,electrical Youth Center: cladding repairs rear wall,window&corner trim replacement S 20,000.00 Facilities building ECC: interior renovations renovations to accomodate new Kindergarten $ 75,000.00 Facilities building,electric,plumbing,sprinkler,fire alarm OT eqt.installations new"swing"at OT area $ 5,000.00 School building NAMS: exterior cladding repairs to brick veneer $ 100,000.00 Facilities building engineering study to verify scope locker room replace boys locker room sink countertop S 2,500.00 School plumbing climbing wall new climbing wall at activity area $ 10,000.00 School building boiler repair boiler#1 repair section/re-gasket $ 10,000.00 Facilities gas,electric Schofield Mill: interior renovations toilet room,entry areas $ 20,000.00 Facilities plumbing,electric,building Stevens Estate: toilet rooms renovations to 2nd floor mens/womens toilets $ 35,000.00 Stevens Estate boiler replace existing boiler $ 150,000.00 Stevens Estate AC replace air conditioner at ballroom area $ 35,000.00 Stevens Estate Senior Center: design&construct new facility at Sutton Street $6,000,000.00 Town Manager all permits General Maintenance: electrical various public buildings as necessary $ 50,000.00 Facilities electrical mist.general repairs&maintenance of existing systems plumbing various public buildings as necessary $ 50,000.00 Facilities plumbing gas various public buildings as necessary $ 10,000.00 Facilities gas building various public buildings as necessary $ 75,000.00 Facilities building fire alarm various public buildings as necessary $ 25,000.00 Facilities fire alarm sprinkler various public buildings as necessary $ 15,000.00 Facilities sprinkler New Recreation Complex design&construct new facility on Chickering $ 8,750,000.00 Town Manager all permits only a portion of this project will require permits Water Treatment Facility ozone filtration system upgrade to primary water filtration system $ 2,650,000.00 DPW electric,plumbing only a portion of this project will require permits WaterlSewer Pump Stations electric systems/generators upgrades to ensure operation during power outages $ 80,000.00 DPW electric w w ° AGENDA COVER MEMORANDUM To: Board of Selectmen Thru: Andrew W. Maylor From: Laurie Burzlaff, Executive Assistant Date: August 10,2018 Re: Use of Common request Request from: Ashley Vaillancourt and Chris Buco For: Approval for use of the Common on Thursday,August 30, 2018 from 6:OOPIVI to 9:OOPM for an end of the season celebration. Reviewed by: Fire Department Comments: The food truck will need proper fire protection and ad current hood cleaning sticker. If propane is for cooking any bottle over 20lbs not attached to the vehicle will need to permitted. Police and Public Works comments, if any,will be provided at the meeting. Use of Town Common Permit 37302 Applicant Ashley Vaillancourt t. 857-272-8164 @ ashleyvarano818@gmail.com Location 0 NORTH ANDOVER TOWN COMMON NORTH ANDOVER, MAO 1845 General Information Name of North Andover group or individual applying Is the purpose of the use of the Town Common for the for use of the Town Common: public display of art, banners, signs and symbols? Ashley Vaillancourt, Chris Buco No Is the purpose of the use of the Town Common to conduct an event where more than twenty people may assemble and/or participate? Yes Date(s) and Time(s) Requested: Time(s): (i.e. 11:OOAM -5:OOPM) Date: 6:OOPM-9:OOPM 08/30/2018 Use of the Town Common for the Purpose of Conducting an Event Please describe the nature and purpose of the event: End of season celebration for North Andover Summer Fitness Series. One beer truck, wine table, and/or food truck for free for participants. Suggested entry donation to be given to a charity or scholarship in town. In total, how many individuals do you anticipate At any one time during the event,what is the maximum attending the event? number of people expected to be on the common? 75 75 Who will be the person or persons representing the applicant who will be present throughout the event? If these persons will be taking shifts, please provide the time of their shifts: Ashley Vaillancourt and Chris Buco Will you be erecting any temporary structures on the common such as tents, fences, athletic equipment? Yes Please describe the size and type of structures: Pop up tents most likely and double fence around drinking area. Will you need access to electricity for this event? Yes For what purpose will you need access to electricity? Food truck will need it most likely. Will you be serving any food or beverages during the Will you be charging a fee for any services provided event? such as food, beverages, games, races, etc.? Please make sure to attach a fee schedule in the uploads Yes section. No Please describe where vehicles of participants in the event will park: Street parking and lot at Steven Coolidge House as approved by site manager Please describe what your clean up plans consist of in terms of number of people assisting in the clean up, how trash will be removed from the common and disposed, etc: Trash barrels around the common will be used. Acknowledgements and Signatures The signer is duly authorized to sign the application on The user of the common will comply with all rules, behalf of the applicant and is a resident of North regulations and conditions applicable to the use of the Andover or works for a non-profit organization whose common. principal place of business is located in North Andover. true true The user of the common will hold the Town, its employees and agents harmless from any and all claims, suits, causes of action,judgments and demands of any nature made or obtained by third parties which result from activities or actions of the Town of North Andover, its agents or servants under this permit and if the judgment is entered against the Town of North Andover, said judgment will be paid by said applicant together with all interest thereon. true Conditions North Andover Community Access & Media, Inc. CAMPO Box 125 NORTH ANDOVER North Andover, MA 01 845 August 9, 2018 Mr. Andrew Maylor Town Manager 120 Main Street North Andover, MA 01845 Dear Mr. Maylor: North Andover CAM, in its role as a loyal servant to the town, respectfully requests that fees totaling $6,217.38, for the build out of the new location of its community media center, be waived. If these fees are to be waived, it will aid in ensuring that our grant money is used more directly for its intended purpose of providing the people of North Andover with state of the art technology to produce locally originated programming right here in town As Executive Director, I am grateful for your thoughtful consideration in this matter. With sincere appreciation, Brian Fraser Executive Director North Andover CAM Ph: 978-687-6570 www.northandovercam.org Fax: 978-691 -5465 Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost Q 407,825.00 m $ - $ 4,893.90 Plumbing Fee $ 611.74 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 611.74 Total fees collected $ 6,217.38 70 Main Street NA Cam Nash Contracting i r Location CAM Studios Store City, State North Andover, MA Drawings Dated 3/30/2018 Project Manager Torn Zahorulko Date of Bid 8/2/2018 Revision General Contractor Nash Contractin , Inc Contact John Oleski Description Bid. Comments General Conditions 71900.00 Su envision 25,000.00 Permit Fees NIC Barricade NIC Dumpsters 1,800.00 Concrete/Floor Prep NIC Concrete cutting and patch NIC Roofing 1,000.00 Framing Drywall 49,200.00 Acoustic Ceiling 10,500.00 Doors/Hardware/Matl's. 22,800.00 Kitchen Cabinets 14,000.00 Allowance see attached Glass and Glazin 2,800.00 Painting 13,500.00 Flooring 20,000,00 Allowance see attached Plumbing 46,800.00 INCLUDES GAS PIPING FOR UNITS HVAC 51,60000 Sprinkler 14,400.00 Electrical 76,800.00 Fire Extinquishers 500.00 Smoke/Fire Systems 8,950.00 Professional Cleaning 1,000.00 Miscellaneous 2,200.00 Sub-Total $370,750.00 Overhead& Profit 37,075.00 Tax Total $407,825.00 cM sews Form i® f t%ORTy 1 O tt�to abs~O Ti °��ra �y1y �SS{CHUSEt TOWN OF NORTH ANDOVER OFFICE OF THE TOWN CLERK 120 MAIN STREET NORTH ANDOVER, MASSACHUSETTS 01845 Joyce A. Bradshaw,CMMC Town Clerk Telephone 978) 688-9501 Fax (978)688-9557 E-mail jjbradshaw io ofiiorth ndov r. v MEMORANDUM TO: 4Regina Kean,Chairman and Members of the Board of Selectmen Andrew W. Maylor,Town Manager FROM: Joyce A.Bradshaw,Town Clerk 9t SUBJECT: September 4,2018 State Primary Liformation DATE: August 7,2018 I wish to request that the Board of Selectmen vote to sign the warrant for the September 4, 2018 State Primary Election. I also want to give and update for the September 4, 2018 State Primary. • The State Primary Election will be held on Tuesday September 4, 2018 at the North Andover High School. The polls are open from 7:00 AM until 8:OOPM. School is in session and it is also the first day of school. • The deadline to register to vote or change party affiliation is Wednesday August 15, 2018. My office will be open until 8:OOPM for registration or absentee voting. • There is no early voting for this election. Absentee ballots are available now. Voters may come to the Town Clerk's office and vote in person. The deadline to vote in person is Friday August 31, 2018 and my office will be open until 5:OOPM for voting only. A ballot may be requested to be mailed. • Voters enrolled in a party - Democrat, Republican, or Libertarian must take that ballot. Unenrolled (No party affiliation) or a political designation can choose which ballot they want. No change of party is needed as status reverts to existing party designation after voting. • Our web site vo w do rthar�d.c�verniam..c(.)i-�i has all necessary information as well as sample ballots (we have 9 different ballots) and links to voter lookup and absentee request forms. Please call or e-mail with any questions. • We may be using poll pads along with paper lists to act as a test site for future poll pad us in elections. We are waiting for approval from the Elections division. I will be at your meeting on Monday August 13, 2018 to answer any questions or provide additional input. North Andover Fire Department Page: 1 Incident Analysis Printed: 08/06/2018 From 07/01/2018 Thru 07/31/2018 Incident Statistics General Statistics Total Incidents: 347 Total Civilian Injuries: 0 Total Civilian Deaths: 0 Total Fire Service Injuries: 0 Total Fire Service Deaths: 0 Total. Incidents With A Dollar Loss: 5 Average Dollar Loss: 33420 Average Suppression Apparatus Responding: 1 Average Suppression personnel Responding: 2 Average EMS Apparatus Responding: I Average EMS Personnel Responding: 2 Average Other Apparatus Responding: 0 Average Other Personnel Responding: 0 Alarm Breakdown Alarm Level Occurrences Percentage 1 0 0.0 2 0 0.0 3 0 0.0 4 0 0.0 5 0 0.0 6 0 0.0 7 0 0.0 8 0 0.0 9 0 0.0 10 0 0.0 Over 10 0 0.0 Unspecified 0 0.0 TOTAL, 347 100.0 Exposure Fare Occurrence Number Of Exposure Fires Occurrences Percentage 1 Exposure Fires 0 0.0 2 Exposure Fires 0 0.0 3 Exposure Fires 0 0.0 4 Exposure Fires 0 0.0 5 Exposure Fires 0 0.0 Over 5 Exposure Fires 0 0.0 Total Exposure Fires 0 0.0 Incident Type Category Breakdown Incident Type Category Occurrences Percentage [100---199] Eire/Explosion 9 2. 6 [200-299] Overpressure Rupture 0 0.0 [300-399] Rescue Call 229 66.0 [400-499] Hazardous Condition 10 2.9 [500-599] Service Call 15 4 .3 North .Andover Fire Department Page : 2 Incident Analysis Printed: 08/06/201.8 From 07/01/2018 Thru 07/31/2016 [600-699] Good Intent Call 14 4 .0 [700--799] False Call 69 19.9 [800-899] Severe Weather/-Natural Disaster 0 0.0 [900-999] Special Type/Complaint 1 0.3 Undetermined 0 0.0 TOTAL 347 100.0 Incident Type Incident Type Occurrences Percentage Building fire 1 0.3 Cooking fire, confined to container 1 0.3 Mobile property (vehicle) fire, other 2 0. 6 MULCH 3 0. 9 Forest, woods or wildland fire 1 0.3 Brush or brush--and-grass mixture fire 1 0.3 Rescue, EMS incident, other 24 6.9 Medical assist, assist EMS crew 2 0.6 Emergency medical service incident, other 93 26.8 EMS call, excluding vehicle accident with injury 92 26.5 Motor vehicle accident with injuries 9 2. 6 Motor vehicle accident with no injuries. 9 2.6 Hazardous condition, Other 2 0. 6 Gas leak (natural gas or LPG) 3 0,9 Oil or other combustible liquid spill 1 0.3 Carbon monoxide incident 1 0.3 Electrical wiring/equipment problem, other 2 0.6 Power line down 1 0.3 Service Call, other 2 0. 6 Lock--out 1 0.3 Water problem, other 1 0.3 Water or steam leak 1 0.3 Smoke or odor removal 2 0.6 Public service assistance, other 6 1.7 Unauthorized burning 2 0.6 Good intent call, other 3 0.9 Dispatched & canceled en route 3 0.9 No incident found on arrival at dispatch address 5 1.4 Steam, other gas mistaken for smoke, other 1 0.3 Smoke scare, odor of smoke 2 0.6 False alarm or false call, other 3 0.9 ERROR OR TRAINING EVENT 1 0.3 System malfunction, other 3 0.9 Smoke detector activation due to malfunction 16 4.6 Heat detector activation due to malfunction 7 2.0 Alarm system sounded due to malfunction 14 4 .0 CO detector activation due to malfunction 1 0.3 Sprinkler activation, no fire - unintentional 1 0.3 Smoke detector activation, no fire - unintentional 10 2.9 Detector activation, no fire - unintentional 1 0.3 Alarm system activation, no fire - unintentional 9 2. 6 Carbon monoxide detector activation, no CO 3 0. 9 Citizen complaint 1 0.3 TOTAL 347 100.0 For Districts: All For Situations: All For Jurisdictions: All For Streets) All North Andover Fire Department Page: 3 Incident Analysis Printed: 08/06/2018 From 07/01/2018 Thru 07/31/2018 For Location: All M � a 440, \\�\ \ \ \\\\\\ ` \\\ we EL MINN. v001, A ... .................. ... «<. ` \,\ MU'aw ` \ \ \\ • Continued narcotic enforcement in known areas of high tr , • CPOP conducting impact patrols, bikeatrols, and p ` \ engagement atyouth center, senior center, and other areas • Fou h' ofjwuty fireworks and festivities at Common \ • Tburth of fuly road race wa lunteered \s heir ti e \ 0 \ ` \ f e 3 � -b \.\ g IMMMStatistical, A, I \ o\ 31 mil 0 0 \\\ \\ N stat-ts\\,m «<. U ly 201,,,,\\ 8, ".' Part i Date, -1_ 2018 dere _ 31 \�\ Part I Incidents -30 10 1 14 -1612 e 10 prior 2 - —_ --_ 34 / uuumud It YNNI iCi>I' n li CL �/ /(/ 0 I�ev 10 CA 0 C~ /b '� � (1)/, t dU * CL rN 01) now a 0 u1 0 W r uta G; r /iii ��1�/ i��/��j/// ;"' � liiiuuuuum uuuuuuu�uuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuu gmw L OL / /1,00, a -17 oil JL low, a et 04,rL w7 Zo I : so k I , CO h°,. LO LP V M 0 it r��r rrr r/ %�//////l;,,;' � .II!�;II�IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII II I III�� J� a® Qi CL lie OAl 0,9 0 tv 110 CL Wool ' 11 f LD 0 BaaIq rr) Cl CA ° IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII I ��1�/ i��/��j/// ;"' � liiiuuuuum uuuuuuu�uuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuu i P low e ll Xo 90 a , ;V ol a� 00 Cf CL to H CIO, I ea Z)o � Iiiiii ml e. 0 00 CZ, CO LO Lf) fl) rlLina D in „ rrrr rrr r/ iii j„ �rim v v 0 ,i x ti$ 94 4,0 11/100 el CIA 1. X410 'loro " eel Ilk x, " ae,, loft* 1010 j/ CCD 0 i 0 1 o N //%0000/ a tg � ON \ ' Ev comin ents,,,, ,m A,,\,,,\u \:: \............... ilgp ll,"\U I 1\1, \ o\\ \\\ \\ \\? \ MahENN"I • Ongoing narcotic enforcement and diversion in certain areas o \\ \ �\ concern fol6wng p with recent complaints and sup1ci\ ` \ • :increase in back to school routes for selective enforcements CPO ' patrols on bikes, downtown area, and irn t patrols along \\ ins o increased traffic anis. �- \ \, _ 3 TMJWN OT'NORTH ANDD E'ER, MA SSA CI I USE T TS Fire Department 795 Chickering Road Street, North Andover, MA 01845 Telejahone 978-688-9.590 Rix 978-688-9594 August 4, 2018 Mr. Andrew Maylor Town Manager Mown of North Andover 120 Main Street North Andover, MA 01.815 Re: Overdose Statistics Dear Mr. Maylor, Attached please find the monthly Overdose Report which breaks down by month incident responses that the North Andover Fire and Police Departments have responded to since January 1, 2014 through Judy 31, 2018. This information has been compiled from AmbuPro Next Caen, OCI Software which the fire department utilizes for our electronic patient care reporting as required by the Massachusetts Department of Public health. Should you have any questions, please do not hesitate to contact me. Thank you, pw" .Jeffrey Deschenes,NREMT, IC EMS Training & Education Officer North.Andover Fire Department EXPLAINA TION OF TERMS Cardiac Arrest: Sudden cardiac arrest is the sudden, unexpected loss of heart function, breathing and consciousness. Sudden cardiac arrest usually results from an electrical disturbance in your heart that disrupts its pumping action, stopping blood flow to the rest of your body. These patients are provided resuscitation efforts with cardiopulmonary resuscitation, airway management and automatic external defibrillator. Cocaine: is a strong stimulant mostly used as a recreational drug. Cocaine has powerful negative effects on the heart and brain. Occasional users run the risk of sudden death with cocaine use. Cocaine use is bad for the heart. Cocaine increases heart rate and blood pressure while constricting the arteries supplying blood to the heart. The result interrupts blood flow to the heart muscle itself, which can cause a heart attack even in young people without heart disease. Dead on Arrival (DOA): Is a terra used to indicate that a patient was found to be already clinically dead upon the arrival of professional medical assistance. Examples of Dead on Arrival according to the Massachusetts Department of Public Health are as follows: Date of Service (DOS): The date in which the fire department responded to a call for assistance. Fentanyl: Is a potent, synthetic opioid analgesic with a rapid onset and short duration of action. Opiate: Opiates are a group of drugs that are used for treating pain. They are derived from opium which comes from the poppy plant. Opiates go by a variety of names including opiates, opioids, and narcotics. The term opiates is sometimes used for close relatives of opium such as codeine, morphine and heroin, while the term opioids is used for the entire class of drugs including synthetic opiates such as Oxycontin. Some of the more common opiates are Codeine, Vicodin, Hycodan, Morphine, Oxycontin, Percoset, Dilaudid, and Fentanyl. Polysubstance Overdose: A polysubstance overdose is when a person is in an intoxicated state without a preference for one particular substance as several substances have been mixed together. Although any combination of three drugs can be used, more likely alcohol is commonly used with other substances such as cocaine and heroin. In the substance abuse context, it usually refers to the use of multiple illicit drugs, however, it can also apply to prescription medications used for nomnedical purposes. People often use multiple substances in an attempt to enhance the effect of a single drug to create a more intense high. NOTES: On July 12, 2016 (Polysubstance Overdose): A person with polysubstance overdose is when a person is in an intoxicated state without a preference for one particular substance as several substance have been mixed together for the ultimate effect. Although any combination of three drugs can be used, more likely alcohol is commonly used with other substances such as cocaine and heroin. On July 17, 2016 (Fentanyl Overdose resulted in Cardiac Arrest): This call was further investigated by the North Andover Police Department. Fentanyl is a potent, synthetic opioid analgesic with a rapid onset and short duration of action. This Fentanyl Overdose is in keeping with the trend that is being seen across the Merrimack Valley. On July 30, 2016 (Cocaine Overdose): Cocaine is a strong stimulant mostly used as a recreational drug. Cocaine has powerful negative effects on the heart and brain. Occasional users run the risk of sudden death with cocaine use. Cocaine use is bad for the heart. Cocaine increases heart rate and blood pressure while constricting the arteries supplying blood to the heart. The result interrupts blood flow to the heart muscle itself, which can cause a heart attack even in young people without heart disease. On August 8, 2016 (Ingested Percocets): The drug Percocet contains a combination of acetaminophen and oxycodone. Oxycodone is an opioid pain medication. An opioid is sometimes called a narcotic. Oxycodone is used to treat moderate to severe pain. On October 30, 2017: The patient accidently overdosed on prescription pain medication. On December 26, 2017: (Oxycodone Overdose) Patient accidently overdosed on prescription pain medication. On February 25, 2018 (Cocaine Overdose): Cocaine is a strong stimulant mostly used as a recreational drug. Cocaine has powerful negative effects on the heart and brain. Occasional users run the risk of sudden death with cocaine use. Cocaine use is bad for the heart. Cocaine increases heart rate and blood pressure while constricting the arteries supplying blood to the heart. The result interrupts blood flow to the heart muscle itself, which can cause a heart attack even in young people without heart disease. North Andover(Fire Department North Andover Fire Department Opiate Overdoses By Month Opiate Overdoses By Month 2014 2'015 5 — 3 4 3 _... _ .._.._._ 2 2 0 i — r---r 0 Jan Feb Mar Apr May Jun Jiul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec North Andover Fire Department. North Andover Fire Department Opiate Overdoses By Month Opiate Overdoses By Month 2016 2017 5 4 -- __ r_ 4 3 — 3 2 _ — CJ d Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec North Andover Fire Department Opiate Overdoses By Month 2018 6 5 3 2 1 0 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec North Andover Fire Department North Andover Fire Department Opiate Overdose Statistics Opiate Overdose Statistics 2014 Resident vs.Non-Residlent 2015 Resident vs. Non-Resident Q Resident M Resident D 0 Non-Resident 0 Non-Resident North Andover Fire Department North Andover Fire Department Opiate Overdose Statistics Opiate Overdose Statistics 2016 Resident vs. Nan-Resident 2017 Resident vs. Non-Resident oI Resident uResident �44�1000� u Non-Resident North Andover Fire Department Opiate Overdose Statistics 2018 Residents vs. Nan,-Resident Resident Non-Resident North Andover Fire Department Opiate Overdoses-Resident vs. Non-Residents Jan. 2014-July 2018 Residents Non-Residents North Andover Fire Department Opiate Overdose Statistics By Year 2018 MMIMMMIM 2017' MEMIM 201 2015 2014 0 s 10 1s 20 25 30 35 40 Number of Overdoses North Andover Fire Department Opiate Overdoses By Gender By Year 2018 14 2017 23 2016 24 2015 21 2014 0 5 10 15 20 25 30 Female M IMialle North Andover Fire Department Opiate Overdoses By Age Group By Year 14 ou'r 12 v 10 ar a, 8 0 w, 0 6 rr 4 I Z 2 0 15-20 21-25 26-30 31-35 36-40 41-45 46-50 51.-55 56-60 604 02014 1 3 6 1 2 0 2 0 0 0 VA 2015 0 6 7 2 4 3 1 2 0 0 4Pi 2016 1 3 12 7 5 3 0 1 1 1 2017 0 5 2 6 4 2 3 1 0 4 02018 2 5 6 2 1 Age Brackets by Year qµ" TO WN OF NORTH A ND0 VER, MASSACHUSETTS � Y Fire Department 795 Chickering Road,�Ireet, Nor lh Ancloverm, MA 01845 Telephone 978-688-9590 Fax 978-688-9594 North Andover Fire Department Overdoses & Intranasal Naloxone Administration January 1, 2014 July 31, 2018 Affiliate Hospital: Lawrence General Hospital I General Street Lawrence, MA 01841 Affiliate Pharmacy: Lawrence General Hospital Medical Director: Dr, George Kondylis Director of Emergency Medical 'Services Lawrence General Hospital Statistical data obtained from ArnbuPro EMS, OCI Software. Total Overdoses for Time Period • Total galls for Opiate Overdoses (OD): It 5 • ALS Narcan Administration: 6 • NAI D Narcan Administration. 58 • NAPD Narcan Administration: 14 • Opiate OD—Cardiac Arrest: 9 • Opiate OI)—Dead On Arrival: 2 • Resident: 65 • Non Resident: 50 Breakdown of Statistics January 2014: -No Incidents February 2014: -Heroin OI)—ALS Used Narcan Incident : 1009124 DOS: 02/01/2014 Resident. Gender: Male Age: 50 North Andover Fire Department Intranasal Naloxone Administration (cont.) February 2014 cont. -Heroin OD--Patient Conscious Upon Arrival Incident#: 1009146 DOS: 02/04/2014 Non-Resident Gender: Male Age: 17 March 2014: -Heroin OD—ALS Used Narcan Incident#: 1009385 DOS: 03/21/2014 Resident Gender: Male Age: 25 April 2014: -No Incidents -Members of the North Andover Fire Department received training by Lawrence General Hospital in the administration of Intranasal Naloxone as a result of a Public Health Emergency declared by Governor Deval Patrick. May 2014: -No Incidents -Intranasal Naloxone was put into service at North Andover Fire Department. June 2014: -Heroin OD to Cardiac Arrest(Narcan Not Administred) Incident#: 1009829 DOS: 06/09/2014 Non-Resident Gender: Male Age: 50 -Heroin OD —NAFD Administered Narcan Incident#: 1009865 DOS: 06/16/2014 Resident Gender: Male Age: 26 -Heroin OD—NAFD Administered Narcan Incident#: 1009902 DOS: 06/25/2015 Non-Resident Gender: Male Age: 28 2 North Andover Fire Department Intranasal Naloxone Administration (cont.) July 2014: -Heroin OD—Patient Conscious Upon Arrival Incident#: 1009967 DOS: 07/08/2014 Resident Gender: Male Age: 28 -Heroin OD —Patient Conscious Upon Arrival Incident#: 1010033 DOS: 07/20/2014 Resident Gender: Female Age: 29 August 2014: -Heroin OD—Patient Conscious Upon Arrival Incident#: 1010202 DOS: 08/26/2014 Non-Resident Gender: Female Age: 25 September 2014: -No Incidents October 2014: -Heroin OD—NAFD Administered Narcan Incident#: 1010404 DOS: 10/05/2014 Resident Gender: Female Age: 24 -Heroin OD—NAFD Administered Narcan Incident#: 1010418 DOS: 10/07/2015 Resident Gender: Female Age: 37 -Heroin OD—NAFD Administered Narcan Incident#: 1010491 DOS: 10/22/2014 Non-Resident Gender: Male Age: 23 3 North Andover Fire Department Intranasal Naloxone Administration (cont.) October 2014 cont. -Heroin OD—NAFD Administered Narcan Incident # 1010554 DOS: 10/31/2014 Non-Resident Gender: Male Age: 3,6 November 2014: -Heroin OD to Cardiac Arrest (Narcan Not Administred) Incident#: 1010560 DOS: 11/2/2014 Non-Resident(Same patient as DOS: 10/31/2014) Gender: Male Age: 35 December,2014: -Heroin OD—Patient Conscious Upon Arrival Incident#: 1010775 DOS: 12/9/2014 Resident Gender: Male Age: 26 January 2015: -Heroin OD —NAFD Administered Narcan Incident#: 1010982 DOS: 01/16/2015 Resident Gender: Male Age: 28 -Heroin OD—NAFD Administered Narcan Incident fi: 1011039 DOS: 01/27/2015 Non-Resident Gender: Male Age: 22 February 2015: -Heroin OD —DOA, Obvious Signs of Death Upon Arrival Incident#: 1011159 DOS: 02/16/2015 Resident Gender: Female Age: 26 -Heroin OD —NAFD Administered Narcan Incident #: 1011172 DOS: 02/18/2015 Resident Gender: Male Age: 27 4 North Andover Fire Department Intranasal Naloxone Administration (cont.) February 2015 cont. -Heroin OD—NAFD Administered Narcan Incident#: 1011203 DOS: 0212412015 Resident Gender: Female Age: 29 -Heroic. OD—NAFD Administered Narcan Incident#: 1011221 DOS: 02/27/2015 Resident Gender: Male Age: 42 March 2015: -Heroin OD to Cardiac Ar-rest (Narcan Not Administred) Incident#: 1011277 DOS: 03/10/2015 Resident Gender: Male Age: 52 April 2015: -Heroin OD—NAFD Administered Narcan Incident#: 1012669 DOS: 04/12/2015 Resident Gender: Male Age; 39 May 2015: -Heroin OD ---NAFD Administered Narcan Incident#: 1011604 DOS: 05/04/2015 Resident Gender: Male Age: 27 -Heroin OD to Cardiac Arrest (Narcan Not Administered) Incident#: 1011770 DOS: 05/31/2015 Resident Gender: Male Age: 54 June 2015: -Heroin OD—Patient Conscious Upon Arrival Incident#: 1011835 DOS: 06/09/2015 Resident Gender: Male Age: 45 5 North Andover Fire Department Intranasal Naloxone Administration (cont.) June 2015 cont. -Heroin OD---NAFD Administered.Narcan Incident#: 101.2693 DOS: 06/13/2015 Resident(Sarre patient as DOS: 04/12/2015) Gender: Male Age: 38 -Heroin OD--patient Conscious Upon Arrival, Nalean administered by parent. Incident#: 1011877 DOS: 06/18/2015 Resident Gender: Male Age: 23 -Heroin OD —NAFD Administered Narcan Incident##: 1012697 DOS: 06/19/2.015 Resident Gender: Male Age: 31 -Heroin.OD ---NAFD Administered Narcan Incident##: 1011911 DOS: 06/23/2015 Resident Gender: Male Age: 38 July 2111.5: -Heroin OD to Cardiac Arrest Narcan Not Administered) Incident#: 1011957 DOS: 07/02/2.015 Non-Resident Gender: Male Age: 24 August 2015: -Heroin OD—NAFD Administered Narcan Incident#. 1012962 DOS: 08/29/2015 Resident Gender: Male Age: 23 September 2015: -Heroin OD—NApD Administered Narcan Incident##: 1013018 DOS: 09/11/2015 Non-Resident Gender: Female Age: 29 6 North Andover Fire Department Intranasal Naloxone Administration (cont.) September 2015. cont.-Heroin OD--Patient Conscious Upon Arrival Incident#: 1013019 DOS: 09/11/2015 Non-Resident Mender: Female Age: 26 -Heroin OD—NAFD Administered Narcan Incident#: 1013031 DOS: 09/13/2015 Resident (Same patient as DCS: 02/27/2015) Gender: Male Age: 43 -Heroin OD--NAFD Administered Narcan Incident 4: 101.3103 DOS: 09/27/2015 Non-Resident Mender: Male Age: 24 October 2015 Heroin OD to Cardiac .Arrest (Narcan Not Administered) Incident#: 3000009 DOS: 10/3/2015 Nan-Resident Gender: Male Age: 34 -Heroin OD—NAPD Administered Narcan Incident#: 3000022 DOS: 10/08/2015 Non-Resident Mender: Male Age: 39 -Heroin CSD NAFD Administered Narcan Incident#: 2000109 DOS: 10/30/2015 Non-Resident Mender: Male Age: 21 -heroin OD—NAFD Administered Narcan Incident#: 3000084 DOS: 10/30/201.5 Non-Resident Gender: Male Age: 49 7 North Andover Fire Department Intranasal Naloxone Administration (cont.) November 2015: -No Incidents December 2015: -No Incidents January 2016: -Heroin OD --NAPD Administered Narcan Incident# 4000163 DOS: 01/04/2016 Non-Resident Gender: Female Age: 26 February 2016: -Heroin OD —NAFD Administered Narcan Incident# 2000418 DOS: 02/02/2016 Resident Gender: Male Age: 43 March 2016: - Heroin OD—NAFD Administered Narcan Incident# 4000293 DOS: 03/03/2016 Non-Resident Gender: Female Age: 39 - Heroin OD—DOA, Obvious Signs of Death Upon Arrival Incident#3000230 DOS: 03/17/2016 Non-Resident Gender: Male Age: 25 -Heroin OD--NAFD Administered Narcan Incident#2000551 DOS: 03/18/2016 Non-Resident Gender: Male Age: 57 -Heroin OD—NAFD Administered Narcan Incident# 3000253 DOS: 03/25/2016 Non-Resident Gender: Female Age: 34 8 North Andover Fire Department Intranasal Naloxone Administration (cont.) April 2016: -Heroin OD—NAPD Administered Narcan Incident# 3000312 DOS: 04/13/2016 Non-Resident Gender: Male Age: 41 -Heroin OD---NAFD Administered Narcan Incident#2000652 DOS: 04/17/2016 Non-Resident Gender: Male Age: 28 May 2016: -Heroin OD —NAFD Administered Narcan Incident# 3000386 DOS: 05/06/2016 Resident Gender: Male Age 35 -Heroin OD - Patient Conscious Upon Arrival Incident# 4000323 DOS: 05/20/2016 Non-Resident Gender: Female Age: 27 June 2016: -Heroin OD—NAPD Administered Narcan Incident# 2000829 DOS: 06/02/2016 Non-Resident Gender: Male Age: 27 July 2016: -Heroin OD --NAFD Administered Narcan Incident# 2000961 DOS: 07/06/2016 Resident Gender: Male Age: 28 -Fentanyl OD to Cardiac Arrest—Under Investigation by NAPD Incident# 3000613 DOS: 07/10/2016 Resident Gender: Male Age: 30 9 North Andover Fire Department Intranasal Naloxone Administration (cont.) July 2016 cont. -Heroin OD—NAFD & LGH ALS Administered Narcan Incident# 3000616 DOS: 07/11/2016 Resident Gender: Male Age: 33 -Unknown Poly Substance OD --NAFD & LGH ALS Interventions Incident# 2000982 DOS: 07/12/2016 Resident Gender: Female Age: 23 -Heroin OD—Patient Conscious Upon Arrival Incident# 2001025 DOS: 07/25/2016 Non-Resident Gender: Male Age: 41 -Cocaine OD—NAFD & LGH ALS Interventions Incident# 3000661 DOS: 07/30/2016 Resident Gender: Female Age: 29 August 2016 -Opiate OD---Patient Conscious Upon Arrival Incident# 3000685 DOS: 08/04/2016 Resident Gender: Male Age: 55 -Heroin OD—NAFD Administered Narcan Incident# 3000697 DOS: 08/07/2016 Non-Resident Gender: Male Age: 40 -Heroin OD—NAFD Administered Narcan Incident# 3000715 DOS: 08/10/2016 Non-Resident Gender: Female Age: 39 10 North Andover Tine Department Intranasal Naloxone Administration (cont.) August 2016 coact. -Heroin OD—Patient Conscious Upon Arrival Incident# 3000731 DOS: 08/151201.6 Nan-Resident Gender: Male Age: 32 -herein OD to Cardiac Arrest Incident# 5000017 DOS: 08,/30/2016 Resident (Sane patient as DOS: 07/06/2016) Gender: Male Age: 28 -Heroin OD--NAFD Administered Narcan Incident# 5000023 DOS: 08/31/2016 Resident Gender: Male Age: 29 ,September 201+6 -Fentanyl OD —NAFD Administered Narean Incident# 5000114 DOS: 09/22/2016 Non-Resident. Gender: Male Age: 25 -heroin OD —Patient Conscious Upon Arrival Incident##4000473 DOS: 09/30/2.016 Non-Resident. Gender: Female Age: 19 October 2016 -Heroin OD —NAFD Administered Narean Incident#4000565 DOS: 1.0/27/201.6 Non-Resident Gender: Male Age: 34 -Heroin OD —NAND Administered Narcan Incident# 5000246 DOS: 10/27/2016 Resident (Same patient as DOS: 07/11/2016) Gender: Male Age: 33 1.1 North Andover Fire Department Intranasal Naloxone Administration (cant.) November 2016 -Heroin OD —NAFD Administered Narcan Incident# 5000276 DOS: 11/02/2016 Resident Gender: Female Age: 6 -Heroin 0:1D—NAFD Administered Narcan. Incident 4 ,4000637 DOS: 11/13/2016 Resident Gender: Male Age: 33 -Herein OD ----NAFD Administered Narcan Incident# 4000664 DOS: 11/21/2016 Resident Gender: Male Age: 38 December 2016 -Fentanyl. OD—NAPD Administered.Narcan Incident#4000700 DOS: 12/06/201.6 Resident Gender~ Male Age 36 -Heroin OD —NAFD Administered Narcan Incident#4000703 DOS: 12/07/2016 Non-Resident Gender: Male Age: 26 -Fentanyl OD—NAFD Administered Narcan Incident:# 5000402 DOS: 12/11/2016 Non-Resident Gender: Female Age: 30 -Heroin OD—NAPD Administered Narcan Incident# 5000403 DOS: 1.2/11/2.016 Resident (Same patient as DOS: 08/31/20116) Gender: Male Age: 30 12 North Andover Fire Department Intranasal Naloxone Administration (cont.) January 2017 -heroin OD - Patient Conscious Upon Arrival Incident# 5000541 DOS: 01/1.4/20117 Non-Resident. Gender: Male Age: 29 -Unknown OD ----NAPD &NAFD Administered Narcan Incident#4000880 DOS: 01/18/2017 Non-Resident Gender: Male Age: 2 February 2017 -Heroin CSD —Patient Conscious Upon Arrival Incident#4000978 DOS: 02/09/2017 Resident (Sarne patient as DOS: 12/11/16) Gender: Male Age: 31 -Heroin OD —NAPD &NAFD Administered Narcan. Incident # 5000650 DOS: 02/15/201.7 Resident Gender: Male Age: 24 -Heroin OD NAFD Administered Narcan Incident# 5000682 DCIS: 02/24/2017 Non-Resident Gender: Male Age: 39 March 2017 -Opiate OD—NAFD Administered Narcan Incident#4001087 DOS: 03/09/2017 Resident Gender. Female Age: 50 Opiate OD to Cardiac Arrest - Family&NAFD Administered Narcan Incident 4 4001168 DOS: 013/26/2017 Resident (Same patient as DOS: 12/11/1.6) Gender: Male Age: 31 13 North Andover Fire Department Intranasal Naloxone Administration (cant.) April 2017 -Heroin Overdose—NAFD Administered Narcan Incident#4001277 DOS: 04/21/2017 Non-Resident Gender: Female Age 25 -Heroin Overdose—Patient Conscious Upon Arrival Incident# 5000931 DOS: 04/26/2017 Resident Gender: Male Age 35 -Opiate Overdose—NAFD Administered Narcan Incident# 5000937 DOS: 04/27/2017 Resident Gender: Male Age: 34 May 2017 -Heroin Overdose--Patient Conscious Upon Arrival Incident#4001323 DOS: 05/02/2017 Resident Gender: Male Age 45 -Heroin Overdose—ALS Administered Narcan Incident #4001360 DOS: 05/12/2017 Non-Resident Gender: Female Age 36 June 2017 -Heroin Overdose—Patient Conscious Upon Arrival Incident# 7000052 DOS: 06/01/2017 Non-Resident Gender: Male Age: 27 14 North Andover Fire Department Intranasal Naloxone Administration (cont.) July 2017 -Opiate Overdose -NAPD &NAFD Administered Narcan Incident# 8000311 DOS: 07/28/2017 Resident Gender: Male Age 41 August 2017 -Opiate Overdose—NAFD Administered Narean Incident # 7000361 DOS: 08/08/2017 Resident Gender: Male Age 39 -Opiate Overdose—NAFD Administered Narcan Incident# 1013247 DOS: 08/23/2017 Resident Gender: Male Age 64 September 2017 -Opiate Overdose - Patient Conscious Upon Arrival Incident# 1013440 DOS: 09/22/2017 Non-Resident Gender: Male Age 33 -Opiate Overdose—Bystander Administered Narcan Incident# 8000412 DOS: 09/28/2017 Resident Gender: Male Age 24 October 2017 -Opiate Overdose—NAFD Administered Narcan Incident# 8000422 DOS: 10/06/2017 Resident Gender: Male Age 35 -Opiate Overdose—ALS Administered Narcan Incident# 1013594 DOS: 10/15/2017 Non-Resident Gender: Male Age: 21 15 North Andover Fire Department Intranasal Naloxone Administration (cont.) October 2017 cont. -Opiate Overdose--NAFD Administered Narcan Incident# 1013595 *Truro patients at same location* DOS: 10/15/2017 Non-Resident Gender: Male Age 54 -Opiate Overdose—NAFD Administered Narcan Incident# 1013595 *Two patients at same location* DOS: 10/15/2017 Non-Resident Gender: Male Age: 46 -Opiate Overdose—NAFD Administered Narcan Incident# 1013668 DOS: 10/24/2017 Resident Gender: Male Age: 67 -Opiate Overdose—ALS Administered Narcan Incident# 7000472 *Unintentional OD of Prescription Medication* DOS: 10/30/2017 Resident Gender: Female Age: 70 November 2017 No Incidents December 2017 -Opiate Overdose----NAFD Administered Narcan Incident# 1014028 DOS: 12/12/2017 Resident Gender: Male Age: 49 -Opiate Overdose—Patient Conscious Upon Arrival Incident# 1014166 *Unintentional OD of Prescription Medication* DOS: 12/26/2017 Resident Gender: Male Age 77 16 North Andover Fire Department Intranasal Naloxone Administration (cant.) December 2017 -Opiate Overdose—NAPD Administered Narcan Incident# 1014181 DOS: 1212912017 Resident Gender: Male Age: 31 January 2018 -Opiate Overdose - NAPD &NAFD Administered Narcan Incident# 1014221 DOS: 01/03/2018 Non-Resident Gender: Male Age: 49 -Opiate Overdose—NAPD &NAFD Administered Narcan Incident# 1014288 DOS: 01/12/2018 Resident Gender: Male Age: 31 -Opiate Overdose—Merrimack College PD and NAFD Administered Narcan Incident# 1014406 DOS: 01/29/2018 Non-Resident Gender: Male Age: 21 -Opiate Overdose—NAPD &NAFD Administered Narcan Incident# 1014421 DOS: 01/31/2018 Non-Resident Gender: Male Age: 21 February 2018 -Cocaine Overdose Incident# 8000608 DOS: 02/25/2018 Resident Gender: Female Age: 35 -Opiate Overdose—NAFD Administered Narcan *A2 on-sighted this returning from Incident# 1014615 Hospital. DOS: 02/26/2018 Non-Resident Gender: Male Age 27 17 North Andover Fire Department Intranasal Naloxone Administration (coat.) March 2018. -Opiate Overdose—Bystander Administered Narcan Incident# 1014798 DOS: 03/20/201 Non-Resident Gender: Male Age: 32 April 2018 -Unknown.Type of Overdose -NAFD Administered Narcan Incident# 1015017 DOS: 04/20/2018 Resident Gender: Male Age: 32 May 2018 -Opiate Overdose—NAPD Administered Narcan Incident# 10151.25 DOS: 05/05/2018 Non-Resident Gender: Male Age: 53 -Opiate Overdose—Patient Conscious Upon Arrival Incident# 1015293 DOS: 05/27/2018 Resident Gender: Male Age: 30 ,lame 2018 -Opiate Overdose—NAPD Administered Narcan Incident# 1015339 DOS: 06/02/2018 Resident Gender: Male Age 32 July 20'18 Opiate Overdose —NAFD Administered Narcan Incident# 1015580 DOS: 07/04/2018 Resident (Same patient as DOS., 12/29/2017) Gender: Male Age 32 -Opiate Overdose—NAFD Administered Narcan Incident# 1.015616 DOS: 07/10/2018 Resident Gender: Male Age: 47 18 North Andover Fire Department Intranasal Naloxone Administration (cont.) July 2018 cont. -Opiate Overdose—Patient Conscious Upon Arrival Incident# 1015699 DOS: 07/20/2018 Resident Gender: Female Age: 29 -Opiate Overdose—Patient Conscious Upon Arrival Incident# 1015729 DOS: 07/24/2018 Non-Resident Gender: Male Age: 27 -Opiate Overdose--Patient Conscious Upon Arrival Incident# 1015758 DOS: 07/27/2018 Resident Gender: Male Age: 26 Respectfully Submitted, Jeffrey Deschenes,NREMT,IC FMS Education&Training Officer North Andover Fire Depailment 19 Permits by Month Building Electric Plumbing Gas Total Misc Total FY 2019 Issued $Generated Issued $Generated Issued $Generated Issued $Generated Permits Revenue $ Jul-18 150 $51,681.38 108 $8,931.22 93 $8,702.41 35 $2,764.00 386 $72,079.01 Aug-18 0 $0.00 Sep-18 0 $0.00 Oct-18 0 $0.00 Nov-18 0 $0.00 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19 May-19 Jun-19 TOTALS 150 $51,681.38 108 $8,931.22 93 $8,702.41 3S $2,764.00 386 $0.00 $72,079.01 FY 19 Bud $775,000.00 $130,000.00 $89,000.00 $36,000.00 $1,030,000.00 FY 19 Act $51,681.38 $8,931.22 $8,702.41 $2,764.00 $72,079.01 $Diff $723,318.62 $121,068.78 $80,297.59 $33,236.00 $957,920.99 Large Permit Fees-Building,Electrical,Plumbing and Gas Jul-18 $3,108 155 Beacon Hill Blvd.-Add 2nd Floor Jul-18 $3,452 350 Holt Road-ReRoof Jul-18 $5,506 1160 GPR-Reno Common Dorm Space at Brooks Jul-18 $3,600 2 Bonny Lane-Addition Jul-18 $3,300 10 Boston Street-Garage FY 2019 Commercial Certificates of Occupancy Issued Month B Permit Number Date BP Issued CO Number CO Issued Est.Value of Permit Business Name Owner Name Contact No# Address On Permit App. July 34339 4/5/2018 36921 7/5/2018 $72,510.00 Dental Office-Dr.Samuels David Samuels,DMD 978-683-5333 1060 Osgood Street 33167 2/15/2018 36957 7/9/2018 $279,194.00 Dental Office-Dr.Yunji Lee Bradstreet Partners LLC* 978-857-9191 70 Main Street-Unit 100 546-2016 11/2/2015 34667 7/11/2018 $1,926,000.00 15 Unit Apartment Building Bradstreet Partners LLC* 978-857-9191 70 Main Street-15 Unit Apartment Bldg. 33448 4/12/2018 37225 7/27/2018 $311,494.00 Grace Point Community Church George Barker* 978-725-0020 25 Orchard Hill Road 35709 5/23/2018 37408 7/27/2018 $119,503.00 The Wine Lab RCG West Mill NA LLC* 617-625-8315 18 High Street Total $2,708,701.00 *Owner of Building/Suite-Not Business Owner Job Posting/Vacancy Log August 9,2018 Date Position Department Hiring Manager Status Posted 7/24/18 Part-Time Dispatch Jonathan Posted on Town website and social Communications Officer Bonanno media,Posted on CJIS. 7/24/18 Part-Time and Reserve NAPD Katie Posted on Town website and social Crossing Guards Kozikowski media,posted on NAPD website. 7/13/18 Assistant Town Manager Town Manager Andrew Maylor Posted on Town website and social media,and on MMA. Requested resumes by August 13, 2018. 7/11/18 Technical Services& Stevens Kathleen Keenan Posted on Town website and social Reference Librarians Memorial media. Posted on Merrimack Valley (Two) Library Library Consortium, and NH Library Association. 7/9/18 Community Support Town Manager Andrew Maylor Posted on Town website and social Coordinator media. Posted on MMA. 7/6/18 Support Services Youth& Rick Gorman Posted on Town website and social Coordinator Recreation media. Posted on free Indeed.com. Services Receiving a high volume of resumes. 6/26/18 Department Assistant Conservation Jen Hughes Hired Jaime Phelan effective 8/13/18 (transferring from the Senior Center). One interview held on 7/10/17, interviews will occur on a rolling basis due to high response. Posted on Town website and social media. Posted on free Indeed.com. 6/22/18 Local Building Inspector Building Paul Hutchins Hired Joel Bedard effective 7/30/18. Interviews conducted through 7/11/18,recommendation pending. Posted on Town website and social media 6/13/18 Alternate Gas/Plumbing Building Eric Kfoury Posted on Town website and social Inspector media 6/13/18 Alternate Electrical Building Eric Kfoury Posted on Town website and social Inspector media. 6/7/18 Part-Time Executive Town Manager Andrew Maylor Interviews conducted through Assistant 7/11/18. Posted on Town website and social media. Posted on free Indeed.com. 5/23/18 Specialty Motor Public Works Time Willett Posted on Town website and social Equipment O erator media. 5/21/18 Part-Time Plumbing/Gas Building Eric Kfoury Ongoing consideration of incoming Inspector resumes. Interviews conducted week of 6/11/18. Posted on Town website and social media, Indeed.com. Job PostingNacancy Log August 9,2018 4/11/18 Electrical Inspector Building Eric Kfoury Hired Nabil Daher effective 7/16/18. Pending employment offer. Hiring decision made but candidate withdrew due to injury. Re-post on 5/31/18. Posted on Town website and social media,Indeed.com,MA Association of Electrical Contractors. 4/9/18 Reserve Firefighter North Andover Chief William John DePippo placed on Reserve list. Fire Dept. McCarthyPending Civil Service approval. 3/7/18 Permanent Reserve NAPD Chief Charles Contingent offers for employment Police Officers(3) Gray made Alexander Soucy,Thomas Hashem,Patrick McGettrick and Cesar Quinones. with hiring recommendation that is pending review. Process ongoing. Civil Service notified applicants to apply by Aril 4, 2018.