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Home My WebLink AboutCopeland Subaru Falmouth RD 2022 License ApplicationAuto Dealer License Type of License Class I Type of Application Amend License Application - $100.00 Type of amendments being requested  Floor Plan  Change in Manager  Change in Vehicle Manufacturer  Change in Corporation  Change in DBA  Change in Location  Check all that apply Required Legal Ad - Additional Fee $82.22 *Abutter notification will be required - Fees associated will depend on number of direct abutters. The Licensing Division will guide applicant through the process once application is submitted. Name of Corporation CopeCodder Enterprises Corp If applicible. Doing Business As: Copeland Subaru Hyannis d/b/a Name of Applicant David First Turner Last Applicant Email dave@countoncopeland.com Applicant Cell Phone (508) 735-5186 Address of Business Address Line 1 City State Zip Code Mailing Address (if different) Address Line 1 City State Zip Code Name of Manager Bryan First Scarpellini Last Manager's Email bryan@countoncopeland.com Manager's Cell Phone (508) 737-4365 New Address Address Line 1 City State Zip Code To access a blank Workers' Comp form: Step One: Click here; Step Two: Fill out blank fields; Step Three: Save to desktop; and, Step Four: Upload to this application. A 'Notarized Letter' stating where repairs will be performed to satisfy the warranty obligations imposed by section 7N.25 of M.G.L., Chapter 190 MGL letter.pdf Copy of Lease Agreement or P&S Lease Agreement - CopeCodder Enterprises Corp_.DOCX NOTICE: Any misstatement in this application or violation of the applicable town ordinances, bylaws or regulations shall be considered sufficient cause for refusal, suspension, or revocation of any and all licenses. 24 Ridgewood Ave Hyannis Massachusetts 02601 95/123 Falmouth Road and 172/180 Walton Ave Hyannis Massachusetts 02601 I warrant the truth of the forgoing statement under the penalty of perjury. Signature Form of Payment Credit Card (Online Only) Payment Type of Application - Amend License Application $100.00 Required Legal Ad Fee - Required Legal Ad Fee $82.22 Subtotal:$182.22 Processing Fees:$5.75 Amount Due: $187.97 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: General Businesses Applicant Information Please Print Legibly Business/Organization Name: Cpt'["'1ch< f v.lt.<p,,'-$lo Cicp 4\,, £!¥c\t•c1 S..'.e1..-� Address: 95 Falmouth Road Are you an employer? Check the appropriate box: I. Gr I am a employer with JC,. employees (full and/ or part-time).* 2. D I am a sole proprietor or partnership and have no employees working for me in any capacity. [No workers' comp. insurance required] 3. D We are a corporation and its officers have exercised their right of exemption per c. 152, § I ( 4 ), and we have no employees. [No workers' comp. insurance required]** 4. D We are a non-profit organization, staffed by volunteers, with no employees. [No workers' comp. insurance req.] Business Type (required): 5.G?Retail 6.D Restaurant/Bar/Eating Establishment 7.D Office and/or Sales (incl. real estate, auto, etc.) 8.D Non-profit 9.D Entertainment I o.O Manufacturing 11.O Health Care 12.O Other -------------• Any applicant that checks box# I must also fill out the section below showing their workers' compensation policy information.**If the corporate officers have exempted themselves, but the corporation has other employees, a workers' compensation policy is required and such anorganization should check box# I.I am an employer that is providing workers' compensation insurance for my employees. Below is the policy information. Insurance Company Name: t'JEM ,c. \.,..,£i.e..,.,.,,½ c"'""f ... ct Insurer's Address: 2 21.. H l l f, lu...._ B lvc.A Policy# or Self-ins. Lie. # 3 \ o�8 o6S (. Co Expiration Date: l O ( & I 2.\)z:1. Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine ofup to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify, under the pains and penalties of perjury that the information provided above is true and correct. Signature: c:::e,s.s a Date: '' I lo I i.�t.' Phone#: Official use only. Do not write in this area, to be completed by city or town official. City or Town: _______________ Permit/License # _____________ _ Issuing Authority (circle one): 1.Board of Health 2. Building Department 3. City ff own Clerk 4. Licensing Board 5. Selectmen's Office 6.Other -------------- Contact Person: __________________ Phone#: _____________ _www.mass.gov/dia --,ACORD'CERTIFICATE OF COPEENT-02 LIAB!LITY INSURANCE o'l 988-2015 ACORD CORPORATTO[ TI{IS CERTIFICATE IS ISSUED AS A ITIATTER OF INFORMATION ONLYAND CONFERS NO RIGHTS UPOI THE CERTIFICATE HoLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR I{EGATIVELY AMENO, EXTEND OR ALTER THE COVERAGE AFFORDEO BYTHE POLICIES BELOW. THIS CERTTFTCATE OF INSURANCE DOES r{OT CONSTTTUTE A CONTRACT BETWEEN THE |SSU|NG TNSURER(S), AUTHORTZEO REPRESET{TATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: lf the certificats holder ls an ADDITIONAL INSUREO, the pollcy(ies) mu$t have AODITIONAL INSURED provlstons or be endoBqd. l, .SUBROGATION lS wAlvEo, 6ublect to the terms and conditions ot tho policy, cortain policles may r6quire .n endor3ement. A siatomont on HIJB lnternational New Enoland222 illiken Boulevard - Fall Rlver, MA 02721 Copoland Enterprlses lnc 970 Wost Ch€stnut St Brockton, MA 02301 THIS lS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAI\iIED ABOVE FOR THE POLICY PERTODINDICATED, NOTWThSTANDING ANY REQUIREI\,{ENT, TERI\,I OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WTH RESPECT TO WHICH THIS CERTIFICATE I\4AY BE ISSUEO OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TOALL THE TERMS, EXCLUSIONS ANO CONDITIONS OF SUCH POLICIES. LIMITS SHO!\N MAY HAVE BEEN REOUCED By pAtO CLA \ilS LIMITS COMI{ERCIAL GENEML LIABIUTY ] "*,r",r*. ! occr* EACH OCCI]RRENCE OAMAGE TO RENTED MED EXP (Anv one DeMn) PERSONAL&ADV NJURY L AGGREGATE LIMITAPPLIES PER: "or"" [ 5gg ! ,o" GE NE RAL AGGR EGATE PRODIICTS . 'OM P/OP AGC AU] owNEo f-- scHEouLED AUTOS ONLY I IAIJTOS lllfoo. o** I-l lliaggx,igtt COMBINED SINGLE LIMIT BOO]LY INJURY S s s $ UTTTBRELLA L|AB L l occuF ExcEssuAB I lc.o,,vs.uaoe EACH OCCURRENCE AGGREGATE oeo | | nere^r or r tr I 1011t202'l 10t112022 x 1 DEscRlPnoN oF oPEMnoNs / LocaTloils / vEHlcLEs (AcoRD 101 , Addirion.l R.mr*s sch.dule, m.y b6 .!t!ch.d ir moo 3p:c. i3 Equi-d) SHOULO,A-iIYOF IHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE IBe",FJiltrJlp,T, p$J=,olti"fio&,;,oi,Jf, wrr_i ei - DEiv-eiE; rN- ACORD 2s (20,t5/03) The ACORD name and logo are registered ma.ks ofACORD All rights reserved. s s Col:eland May L6,2O22 To whom it may concern: All dealership warranty obligations will be performed at 95 Falmouth Road, Hyannis, Massachusetts, as imposed by SectionTN.25of M.G.L.CH. 190. lhave attached M.G.L. CH. 190 section 7N.25 for your convenience. David F. Turner Jr. Treasurer CopeCodder Enterprises Corp. d/b/a Copela nd Subaru Hyannis Public My Commission Expires 2026