Cardiac Arrhythmia Syndromes Foundation, Inc

20 Pages·2016·3.05 MB·English

Cardiac Arrhythmia Syndromes Foundation (CAS Foundation) Application # 2 or 3
The Commonwealth of Massachusetts
Executive Office of Health and Human Services
Department of Public Health
Bureau of Health Care Safety and Quality
Medical Use of Marijuana Program
99 Chauncy Street, 11th Floor, Boston, MA 02111
SITING PROFILE:
Request of for a Certificate of Registration to
Operate a Registered Marijuana Dispensary
INSTRUCTIONS
This opplicotion fonn is to be completed by a non-profit corporation that wishes to apply for a Certificate of Registration to operate o
Registered Marijuana Dispensary ("RMD") in Massachusetts, and hos been invited by the Department of Public Health (the
"Department") to submit a Siting Profile.
If invited by the Department to submit more than one Siting Profile, you must submit a separate Siting Profile and attachments for
coch proposed RMD. Please identify each application of multiple applications by designating it as Application I, 2 or 3 in the heoder
ofc och application page. Please note that no executive, member, or any entity owned or controlled by such an executive or member,
may directly or indirectly control more than three RMDs.
Unless indicated otherwise, all responses must be typed into the application forms. Handwritten responses will not be accepted. Pleose
note thot character limits include spaces.
Attachments should be labelled or marked so as to identify the question to which it relates.
Each submitted application must be a complete, collated response, printed single-sided, and secured with a binder clip (no ring
binders, spiral binding. staples, or folders).
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Cardiac Arrtlythmla Syndromes Foundation (CAS Foundation)
Application # 2 of 3
Mail or hand-deliver the Siting Profile, with all required attachments, to:
Department of Public Health
Medical Use of Marijuana Program
RMD Applications
99 Chauncy Street. I I 1h Floor
Boston, MA 02111
REVIEW
Applications are reviewed in the order they nre received. Aller a completed application packet is received by the Department. the
Department will review the information and will contact the applicant if clarifications/updates to the submitted application materials
are needed. The Department will notify the applicant whether they have met the standards necessary to receive a Provisional
Certi ficnte of Registration.
PROVISIONAL CERTIFICATE OF REGISTRATION
Applicants have one year from the date of the submission ofthe Management and Operations Profile to receive a Provisional
Certificate of Registration. lfan applicant does not receive a Provisional of Certificate of Registration after one year, the applicant
must submit a new Application ofI ntent and fee.
REGULATIONS
For complete infonnation regarding registration of an RMD, please refer to I 05 CMR 725.100.
It is the applicant's responsibility to ensure that all responses arc consistent with the requirements of 105 CMR 725.000, et seq., and
any requirements specified by the Department. as applicable.
PUBLIC RECORDS
Please note that all application responses, including nil attachments, will be subject to release pursuant to a public records request. as
redacted pursuant to the requirements at M.G.L. c. 4, § 7(26).
tnfonnatlon on this page has been reviewed by the applicant, and where provided b llcant,
Is accurate and complete, as Indicated by the lnlllals of the authorized slgnatcrv her
Siling Profile - Puge :?
Cardiac Annythmia Syndromes Foundallon (CAS Foundation)
Application # 2 of 3
QUESTIONS
If additional infonnntion is needed regarding the RMD application process, please contact the Medical Use of Marijuana Program at
617-660-5370 or RMDaoplicationn ~late.ma.us.
CHECKLIST
The fonns and documents listed below must accompany each application, and be submitted as outlined above:
I!! A fully and properly completed Siting Profile, signed by an authorized signatory of the applicant non-profit corporation (the
"Corporation")
t!f Evidence ofinterest in property, by location (as outlined in Section B)
l!'.I Letter(s) of local support or non-opposition (as outlined in Section C)
Information on this page has been reviewed by the applicant, and when! provided by. cant,
Is accurate and complete, as Indicated by the Initials of the authorized slsnatorv here
Siling Profile - J>oge 3
Cardiac Arrhythmia Syndromes Foundation (CAS Foundallon) Appllcallon # 2 or 3
SECTION A: APPLICANT INFORMATION
2.-
I. Cardiac Arrhythmia Syndromes Found4tion, Inc. aka -CAS Foundation
Legal name of Corporalion
Name of Corporation's Chief Executive Officer
9 Banlct Stm:t. Unit # 335
3. Andover, MA 01810
Address of Corporation (Street, Cityffown, Zip Code)
4.
Applicant point of contact (mune of person Department of Public Health should contact regarding this application)
Applicant point of contact's c·mail address
7. Number of applications: How many Siting Profiles do you intend to submit? _J ___
lnfonnatlon on this page has been revlewed by the appllcilnt, ;md where provided by w pplleant,
ls accurate and complete, as Indicated by the lnltlals of the authorized signatory here:
Siting Profile - Page 4
Cardiac Anhythmla Syndromes Foundallon (CAS Foundallon) Application # 2 of 3
SECTION B: PROPOSED LOCATION(S)
Provide the physical address oft he proposed dispensary site and the physical address oft he addilonal location, ifa ny, where
marijuana/or medical use will be cultivated or processed.
Attach supporting documl!nts as evidence ofi nterest in t/11! property, by location. Interest may be demonstrated by (a) a clear legal
title lo the proposed site; {b) an option to purchase the proposed site; (c) a lease; (d) a legally enforceable agreement lo give such title
under (a) or (b), or such lease under (c), in the event that Department determines that the applicant qualifies for registration as a
RMD; or (e) evidence ofb inding permission to use the premises.
Location Full Address County
Somerville, 67 Broadway Middlc:sc:1t
1 Dispensing
Fitchburg, One (I) Oak Hill Road Worccstc:r
2 Cultivation
Fitchburg. One (I) Oak Hill Rood Worc:cstc:r
3 Processing
D Check here if the applicant would consider a location other than the county or physical address provided within this application.
Information on this page has been reviewed by the appllcant, and where provided . pllcant,
ls accurate and complete, as Indicated by the Initials of the authorized signatory her _
Siting Profile - l'llgc 5
Cardiac Arrhythmia Syndromes Foundation (CAS Foundation)
Application 2 of 3
SECTION C: LEITER OF SUPPORT OR NON-OPPOSITION
Anach a letter ofs upport or non-opposition, using one oft he templates below (Option A or 8), signed by the local municipality in which the applicant intends to
locate a dispensary. The applicant may choose to use either template, in consultation with the host community. Ift he applicant is proposing a dispensary location
and a separate cultivation/processing location, the applicant must submit a letter ofs upport or non-opposition from both municipalities. This letter may be signed
by (a) the ChiefE xecutive Officer/ChiefA dministrative Officer, as appropriate.for the desired m1111icipality: or (b) the City Council, Board ofA lderman, or Board
ofS electmen for the desired municipality. The Idler ofs upport or nan-opposition must contain the Ian page as pnn/dd below. The Idler must be printed on
the municipality's offldal later/read.
Template Option A: Use this language ifsignatory is a Chief Executive Officer/Chief Administrative Officer
/, (Name ofp enon), do hereby provide (:rupportlnon-oppo:ritlon) to (name ofn on-profit argani::ation) IO operate o Registered ManJl.llllUl Dispensnry ("RMO") in (name ofc ity or
town)
I ha1."e verified with the appropriate local afficiall that the propo1ed RMDf acility i:r located in a :aning district that allows such use by right or punllillll ta /or:al permi11ing.
Name and Title oflndividuol
Signature
Date
Template Option B: Use this language if signatory is acting on behalf of a City Council, Board of Alderman. or Board of Selectman
The (name ofc ounr:i/lboard], docs hereby provide (s11pportlnon-oppositio11) lo [name ofn on-profit organi:atlan) to operate a Registered Marijuonn Dispensnry in (name ofc ity or
town]. I hnve been outhorilCd lo provide lhis lcller on behalf of the (name ofc ouncillboarclj by a vote IDken 11t 11 duly noticed meeting held on [dnte).
The (namt ofc ouncil/board] has verified with the appropriate local officials that the propo1td RMDf acility is located in a :oning district that allow3 s11eh use by righJ or pursuant
to local ptrmitling.
Name and Title of lndividuol (or person outhorilCd to net on behalf ofc ouncil or board) (add more line:r for names ifn eeded)
Si8llllture (add more Ii Ms for signatures ifn eeded)
Dace
Information on this page has been reviewed by the applicant, and where provided by the applicant,
Is accurate and complete, as Indicated by the Initials of the authorized signatory here:~
Siting Profile - Page 6
CAS Foundation. Application # 2 of 3
OFFICE OF THE MAYOR
STEPHEN L. DINATALE AARON TOURIGNY
CHIEF OF STAFF
MAYOR
[email protected]
166 BOULDER DRIVE
FITCHBURG, MA 01420 JOAN DAVID
ADMINISTRATIVE AIDE
TEL. (978) 829·1801
[email protected]
May 9, 2016
The CAS Foundation
Attn: Jayne Vining
9 Bartlet Street #335
Andover,MA 01810
I, Stephen L. DiNatale, Mayor of the City of Fitchburg, do hereby provide this letter of non-opposition
to the CAS Foundation, Inc. to operate a Registered Marijuana Dispensary (RMD) facility in the City
of Fitchburg, MA.
I have verified with the appropriate local officials that the proposed RMD facility is located in
a zoning district that allows such use by right or pursuant to local permitting.
Respectfully yours,
CAS Foundation, Application # 2 of 3
ONE OAK HILL, LLC
1 Oak Hill Road
Fitchburg, Massachusetts 01421
March 2, 2016
RE: Cardiac Arrhythmia Syndromes Foundation, Inc. ("CAS").
Letter of Intent to Lease; 1 Oak Hill Road, Fitchburg, MA
On behalf of ONE OAK HILL, LLC, owner of 1 Oak Hill Road, Fitchburg, Massachusetts,
we are pleased to present the following binding Letter of Intent to Lease to CAS. If these
terms are acceptable, please have the appropriate authority indicate so by signing below
and returning a copy of this letter to me. I would then forward a lease draft for your
review.
LEASE PROPOSAL
Property: 1 Oak Hill Road, Fitchburg, Massachusetts
Building Size: 244,120 RSF
Landlord: ONE OAK HILL, LLC
Tenant: CAS
Use(s): Business and professional offices as well as laboratory,
research and manUfacturing facilities and other uses
legally permitted under the laws of the Commonwealth of
Massachusetts, including the operation of a Medical
Marijuana Cultivation Facility pursuant to Chapter 369 of
the Acts of 2012, An Act for the Humanitarian Medical Use
of Marijuana, and 105 CMR 725.100 et seq.
Premises: Approximately 70,000 rentable square feet located on the
first and second floor of Building Four. The Premises shall
be measured according to SOMA standards by Landlord's
architect.
Term: Ten (10) years.
Option to Renew: CAS shall have the option to renew the term of the
Lease for one (1) five (5) year period at Fair Market
Value, but not less than previous year's rent and
shall increase $0.50 per square foot per year. The
CAS Foundation, Application # 2 of 3
Pagel of4
renewal option shall be exercised no later than nine
(9) months prior to the expiration of the then Lease
Term.
Lease/Rent
Commencement: On July 1, 2016 CAS will commence paying its pro-rata
share of all operating expenses, insurance and taxes, as
well for its utilities, cleaning and trash removal for the
Premises.
ABSOLUTE
NNN Rent: Year 1: $8.00 ABSOLUTE NNN
Year2: $8.50 ABSOLUTE NNN
Year3: $9.00 ABSOLUTE NNN
Year4: $9.50 ABSOLUTE NNN
Year 5: $10.00 ABSOLUTE NNN
Year6: $10.50 ABSOLUTE NNN
Year7: $11.00 ABSOLUTE NNN
Years: $11.50 ABSOLUTE NNN
Year9: $12.00 ABSOLUTE NNN
Year 10: $12.50 ABSOLUTE NNN
Type of Lease: This would be a ABSOLUTE triple net lease whereby CAS
pays for its Premises expenses and for its pro-rata share of
common area operating expenses, Premises real estate
taxes, insurance and building maintenance including
parking lot, roof and structure.
Any costs associated with increased security shall be a
CASI tenant specific expense.
Tenant Utilities: The Premises shall be separately metered or sub-metered
and billed accordingly. CAS shall be responsible for its
utility costs (including, but not limited to electricity, water
and gas), which shall be based on CAS's consumption.
Right to Audit: CAS shall have the annual right to audit Operating
Expenses and Real Estate Taxes by a nationally
recognized accounting firm, which shall not be on a
contingent fee basis.
Tenant Improvements: CAS would take the space "As Is." Any additional amounts
required for tenant improvements will be provided by CAS.
CAS Foundation, Application # 2 of 3
Pagel of4
CAS shall also be responsible for its own telephone and
data requirements and costs associated therewith.
Also, at CAS's request, Landlord would oversee CAS's
improvements, including design, engineering, permitting
and construction, for a 3% construction management fee.
Building Systems: Landlord will be responsible for delivering at Lease
Commencement all base building common systems in
good working order.
ADA: Landlord shall be responsible to keep the common areas
of the Premises in compliance with the Americans with
Disabilities Act C-ADA"). CAS shall be responsible for ADA
compliance associated with its design, construction and
use of the Premises.
Sublease & Assignment: CAS shall have the right to assign the entire lease, and to
sublease all or part of the Premises, with Landlord's
consent, which consent shall not to be unreasonably
withheld.
Signage: Landlord agrees to provide, if requested by CAS, directory
signage in either the lobby, monument signage at either
the parking entrance and CAS entry signage at
its Premises. All signage will be in compliance with local
and Department of Public Health rules and regulations.
Parking:
CAS will be allocated its pro rata share of parking
spaces at the Premises. Landlord will provide CAS some
reserved parking.
Access:
CAS shall be provided 24-hour, seven days per
week, access to the building and Premises. The
building is secured by a common area card access
system. CAS may install Its own security system for
its Premises and coordinate its system at the head
end with Landlord's system to allow employees to carry
Life Safety: one access card.
Environmental: The building is fully-sprinklered.
At CAS's request, Landlord agrees to share with CAS
its most current Phase I & II environmental reports for
the Premises, which indicate there are no
Security Deposit: environmental conditions at the Premises.
To be determined; and subject to Landlord's
Contingency: satisfactory review of CAS's financial statements.
Any lease agreed to by the parties shall be contingent
on the CAS obtaining approval for its proposed use from
the