Fillable Host Community Agreement Proposal Screening Form Beverly Final (City of Beverly MA)

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Host Community Agreement Proposal Screening Form Beverly Final (City of Beverly MA)

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CITY of BEVERLY
191 Cabot Street
Beverly, Massachusetts 01915
Phone (978) 921-6000
Fax (978) 921-6187
Proposals for Marijuana
Establishment Host Community Agreement
January 24, 2019
The process outlined herein is intended to provide guidance to persons and/or entities seeking to
enter into a Host Community Agreement (“HCA”) to operate a marijuana establishment in Beverly.
The City reserves the right to alter, amend, and/or deviate from this process at any time, in its
discretion.
1. Timeline. The City will open the process for receiving proposals January 24, 2019. Proposals
will be reviewed on a rolling basis.
2. Review. In considering HCA proposals, the City seeks to work with the highly qualified
operators at locations that have minimal negative impacts on the neighborhood and the
community at large, among other things. Proposals will be initially reviewed by City Staff who
will then advise the Mayor on the benefits or lack thereof of the proposals. The City, in its
discretion, will thereafter meet with proposers to further discuss proposals and the possibility of
entering into a HCA.
3. Submission. Four (4) copies and a digital copy of the attached Marijuana Establishment Host
Community Agreement Proposal form and all required supporting materials, along with any
other materials an operator would like the City to consider, shall be submitted to the City
through the City Planning Department. Incomplete proposals will not be reviewed.
4. Supporting materials. The following supporting materials must accompany each Proposal:
a. Evidence of site control, either through deeded ownership, an executed lease, a real estate
contract contingent upon successful licensing and permitting, or a notarized letter of intent
by the owner of the property indicating intent to lease or sell the premises to the applicant
upon successful licensing and permitting.
b. A completed copy of the entire application, in draft or final form, by the establishment to the
Massachusetts Cannabis Control Commission (CCC).
c. Resumes for every manager, director, or officer of the establishment.
d. Completed Criminal Offender Record Information (“CORI”) Open Access
Acknowledgement Forms for every manager, director, officer, or investor of the
establishment (available here: https://mass-cannabis-control.com/wp-content/
uploads/2018/05/CORI-Disclosure-IVS-Release-Authorization-Forms.pdf) accompanied by a
payment of fifty dollars ($50) per form, payable to the Commonwealth of Massachusetts in
money order or cashier’s/treasurer’s check.
e. Copy of the establishment’s Business Plan.
Page 1
City of Beverly – Screening Form for Marijuana Establishment Host Community Agreement Proposals
Page 2
f. Copy of the establishment’s Security Plan.
g. Description and scope of the transportation analysis to be performed as a requirement of the
Special Permit application.
h. Copy of financial records or letter of financing demonstrating capitalization or investment to
ensure the establishment’s solvency and successful operation.
5. Minimum HCA provisions. Should the City decide to proceed with an HCA, proposers should
expect that the HCA will include, at a minimum, the provisions set forth below. In its discretion
the City may require a HCA that alters, modifies and/or supplements these provisions.
a. A commitment to pay the City a Community Impact Fee not to exceed three percent (3.0%)
of the establishment’s gross annual sales, with an initial payment in the first year of
operation of twenty-five thousand dollars ($25,000) payable to the City on the facility’s
opening date and the remaining balance due within twelve (12) months of opening.
b. A commitment to pay all required taxes, betterments, assessments, and utility charges in
addition to the Community Impact Fee.
c. Operator’s obligation to file annual financial statements with the City. Copies of financial
statements provided to the CCC in connection with state licensing shall be sufficient for the
purposes of this requirement.
d. Operator’s obligation to apply for and comply with the requirements of any applicable City
permit and/or license. Operator’s acknowledgement that an executed HCA does not
guarantee that a special permit or any other City permit or license will be granted.
e. Operator’s obligation to design, construct, renovate, or improve the facilities to reflect high
quality construction standards that improve and/or complement the general design aesthetic
of the neighborhood, are consistent with design guidelines and the zoning code, and ensure
energy efficiency and minimal environmental impact. To the fullest extent practicable, a
facility’s power supply shall use renewable energy sources.
f. Facility staff shall participate in City-sponsored educational programs on public health and
drug abuse prevention.
g. Operator’s obligation to submit establishment’s security plan to the Beverly Chief of Police
annually and receive approval of such plan each year. Upon the request of the City, the
Operator shall meet with the Beverly Police Department to review operational concerns or
other issues and shall report to the Police within 24 hours of becoming aware of: diversion
of marijuana, inventory discrepancies, theft, loss or other criminal action, discrepancy in
weight or inventory during transportation, vehicle accidents, diversions, losses or other
reportable incidents that occur during transport, any suspicious act involving sale,
cultivation, distribution, process or production of marijuana, unauthorized destruction of
marijuana, loss or unauthorized alteration of the establishment’s records, alarm activation or
other event that requires public safety personnel to respond, failure of security alarm due to
power loss or mechanical failure expected to last longer than eight hours, and any other
City of Beverly – Screening Form for Marijuana Establishment Host Community Agreement Proposals
Page 3
breach of security. Operator will site interior and exterior security cameras in coordination
with the Beverly Police Department, including two (2) cameras located so as to provide an
unobstructed view in each direction of the public way(s) on which the facility is located, and
provide unimpeded access to all security camera feeds to the Beverly Police Department.
Operator will participate with the Police Department in a comprehensive diversion
prevention plan.
h. Operator shall comply with all CCC requirements regarding Criminal Offender Record
Information (CORI) review for any new individual for whom the Marijuana Establishment
seeks a marijuana establishment agent registration and forthwith submit all necessary
information to the Police Chief who will then make a determination as to whether the
individual is suitable to hold the position.
i. Operator shall refuse to complete a transaction with any customer if the customer appears to
be under the influence of drugs or alcohol.
j. Operator shall verify the legal age of all customers using a government-issued identification
prior to the customer being admitted into the facility and again prior to the completion of a
transaction. Applicant must utilize electronic identification verification measures.
k. If any term or condition of the HCA shall to any extent be held invalid, illegal or
unenforceable by a court of competent jurisdiction or by regulation, the validity, legality,
and enforceability of the remaining terms and conditions of HCA shall not be deemed
affected thereby unless one or both parties would be substantially or materially prejudiced.
Further, the Operators agree it will not challenge, in any jurisdiction, the enforceability of
any provision included in the HCA; and to the extent the validity of the HCA is challenged
by the Operator in a court of competent jurisdiction, the Operator shall pay for all reasonable
fees and costs incurred by the City in the defense thereof.
Proposers are welcome and encouraged to propose additional benefits for the City’s consideration.
In addition, the City may also require direct impact mitigation particular to the specific location
proposed by the applicant and its specific impacts.
6. Favorable criteria. Favorable criteria include, but are not limited to: (a) demonstrated direct
experience in the cannabis industry or a similar industry; (b) managers, directors, officers,
investors, and others related to the establishment are free of any disqualifying criminal
convictions; (c) managers, directors, officers, investors, and others related to the establishment
are representative of a diverse community; (d) financial records, Business Plan, and other
documentation that demonstrates strong capitalization or access to financing to ensure success
of business; (e) strong commitment to the community through investment and outreach; (f)
demonstration of a clear understanding of the zoning regulations; (g) proposed design and
operation of a facility with minimal impact upon the surrounding neighborhood; (h)
demonstration of a commitment to providing indirect community support to the City through (i)
use of local vendors (e.g.
, whether and how local businesses and vendors will be prioritized in
the provision of goods and services called for in the construction, maintenance, and continued
operation of the facility), (ii) hiring of Beverly residents (include process for recruitment), and
City of Beverly – Screening Form for Marijuana Establishment Host Community Agreement Proposals
Page 4
(iii) payment of “living wages” (describe how such salaries and hourly wage rates may qualify
as a “living wage,” as defined by the Massachusetts Institute of Technology as “the hourly rate
that an individual must earn to support their family, if they are the sole provider and are working
full-time (2080 hours per year)”; and (i) Demonstration of commitment to the Beverly
community through charitable contributions to Beverly-based nonprofits or to the City of
Beverly for a public purpose.
The City reserves the right to consider any additional criteria.
City of Beverly – Screening Form for Marijuana Establishment Host Community Agreement Proposals
Page 5
CITY OF BEVERLY
MARIJUANA ESTABLISHMENT
HOST COMMUNITY AGREEMENT PROPOSAL
File four (4) copies, plus one digital version, of the proposal completed in full accompanied by all
required supporting materials with Beverly Planning Department, 191 Cabot Street, Beverly, MA
01915. Please respond to each question as fully as possible, attaching separate sheets as necessary.
INDICATE TYPE(S) OF ESTABLISHMENT(S):
☐ CO-LOCATED MARIJUANA OPERATION
☐ CRAFT MARIJUANA COOPERATIVE
☐ INDEPENDENT TESTING LABORATORY
☐ MARIJUANA CULTIVATOR (indicate tier: _________)
☐ MARIJUANA PRODUCT MANUFACTURER
☐ MARIJUANA RESEARCH FACILITY
☐ MARIJUANA RETAILER
☐ MARIJUANA TRANSPORTER
☐ MARIJUANA MICRO-BUSINESS
☐ MEDICAL MARIJUANA TREATMENT CENTER or REGISTERED MARIJUANA
DISPENSARY (RMD)
APPLICANT (Corporation Name / Business Name (D/B/A) / Sole Proprietor, etc.)
Location of Proposed Establishment Contact Name
Address Mailing Address (if different)
City/Town State Zip City/Town State Zip
Telephone Number Fax Number Business Telephone Number Fax Number
Tax I.D. Number Massachusetts Cannabis Industry Portal Number
Email Address Website
Economic Empowerment Applicant: ☐ Yes ☐ No
City of Beverly – Screening Form for Marijuana Establishment Host Community Agreement Proposals
Page 6
1.
Describe the form of ownership of the applicant (e.g., corporation, limited liability company,
or limited partnership, sole proprietor, etc.)
Provide copies are any articles of organization, certificate of organization or other similar
document filed with the Massachusetts Secretary of State and complete the Corporate
Information required for Business Entities (see page 8).
2.
Is the physical location of the business leased or owned? ____________________________
Provide copy of purchase and sale agreement, deed, or lease.
3. Do you own or have any interest in another marijuana establishment(s), including registered
marijuana dispensaries or medical marijuana treatment centers? ☐ Yes ☐ No
If yes, please provide name and physical location of any other such establishments:
______________________________________________________________________________
______________________________________________________________________________
4. Please specify your intended days and hours of operation:
______________________________________________________________________________
5.
Will you agree to the minimum HCA provisions as outlined in Section 5? ☐ Yes ☐ No
6.
Does any owner, director, manager, officer, or investor have an existing or previously
existing business or property in Beverly that owes any delinquent taxes, fees, fines, penalties,
or other monies to the City of Beverly? ☐ Yes ☐ No
7. Does any owner, director, manager, officer, or investor have an existing or previously
existing business or property in any other municipality that owes any delinquent taxes, fees,
fines, penalties, or other monies to said municipality? ☐ Yes ☐ No
8.
Has any owner, manager, director, officer, investor, or other individual affiliated with the
applicant been convicted of any criminal disqualifying conditions, offenses, and violations
pursuant to 935 CMR 500? ☐ Yes ☐ No
If Yes, please explain: _____________________________________________________
________________________________________________________________________
________________________________________________________________________________________
City of Beverly – Screening Form for Marijuana Establishment Host Community Agreement Proposals
Page 7
Please respond to the following questions with separate attachments to be submitted with this
proposal. Please check box to demonstrate resp
onses are attached.
9. Do you have experience managing a business in the marijuana industry? Please describe.
☐ Response attached
10.
Describe in detail the premises to be licensed, including plans for customer flow, security,
delivery, lighting, and signage.
☐ Response attached
11.
How will you prevent the diversion of marijuana from your establishment?
☐ Response attached
12
. Please desc
ribe any ways in which the business or its affiliates have demonstrated a
commitment to community involvement.
☐ Response attached
13. Please indicate any additional conditions, considerations, or benefits you wish to propose for
the HCA.
☐ Response attached
14. Please submit a diagram of the premises. Diagrams should be as accurate and to scale. Label
the areas of your diagram including entrances, office area, kitchen, storage areas, restrooms,
parking locations, signage, loading areas, transaction locations, etc.
☐ Diagram attached
15. Submission of a proposal does not endow any proposer with any legal right or create any
legal obligation on the part of the City to execute a HCA. The City may in its discretion
decline to execute a HCA.
______________________________________ _______________________________________
Signature of Applicant or Corporate Officer(s) Signature of Applicant or
Corporate Officer(s)
______________________________________ _______________________________________
Print Name Print Name
Date of Proposal
City of Beverly – Screening Form for Marijuana Establishment Host Community Agreement Proposals
Page 8
Corporate Information Required for Business Entities
Responses to questions below must match information on file with the MA Secretary of State’s office.
1. Exact legal name: _____________________________________________________________________
2. Doing Business As, if any: ______________________________________________________________
3. Date of filing with Secretary of State: _______________ State in which you are formed: ____________
4. If not a MA business entity, date on which you were authorized to transact business in the State of MA
___________________________________________________________________________________
5. List the name, addresses and title of officers, directors and/or members and list the percentage ownership:
(attach additional sheets as needed)
NAME ADDRESS TITLE % OWNERSHIP
(Stock ownership in n
on-publicly traded companies must add up to 100 %.)
_______
________________________________ ________________________
Signature of Duly Authorized Person Date
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Completed 14 July 2020

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