FIDELITY WELLNESS CENTER, INC. - Massachusetts

FIDELITY WELLNESS CENTER, INC.

28 Oakville Street, Lynn, MA 01905

DATE: May 3, 2017

TO: Department of Public Health Medical Use of Marijuana Program RMD Applications 99 Chauncy Street 111h Floor Boston, MA 02111

RE: Siting Profile 1 of 1

To whom it may concern,

Fidelity Wellness Center, Inc. ("FWC") is pleased to submit to the Department our Siting Profile for our proposed co-located RMD in Holyoke.

Our proposed RMD in Holyoke is located at 380 R Dwight Street in Building B. FWC plans on occupying the entire building (approx. 28,500 sf.) and will not share any space with any other entity or tenant.

We have garnered support from the Holyoke Mayor and other stakeholders in the community. Upon receipt of a Provisional Certificate of Registration we will immediately submit an application for a Special Permit from the Holyoke City Council.

Along with our completed Siting Profile we included several attachments that may help you in your review of the application.

Attachment 1. Attachment 2. Attachment 3. Attachment 4.

Letter of Intent to Lease 380 R Dwight Street, Building B. Letter of Support from the Mayor of Holyoke Section 7.10 (Medical Marijuana Facilities) of the Holyoke Zoning Ordinance Section 4.3 (Table of Principal Uses) of the Holyoke Zoning Ordinance

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 for a Certificate of Registration to Operate a Registered Marijuana Dispensary

INSTRUCTIONS

This application form is to be completed by a non-profit corporation that wishes to apply for a Certificate of Registration to operate a Registered Marijuana Dispensary ("RMD") in Massachusetts, and has 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 each proposed RMD. Please identify each application of multiple applications by designating it as Application 1, 2 or 3 in the header of each 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. Please note that 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).

Application _1_ of_l__

Applicant Non-Profit Corporation Fidelity Wellness Center, Inc.

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, 11th Floor

Boston, MA 02111

REVIEW

Applications are reviewed in the order they are received. After 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 Certificate of Registration.

PROVISIONAL CERTIFICATE OF REGISTRATION

Applicants must receive a Provisional Certificate of Registration from the Department within 1 year ofthe date of the invitation letter from the Department to submit a Siting Profile. If the applicant does not meet this deadline, the application will be considered to have expired. Should the applicant wish to proceed with obtaining a Certificate of Registration, a new application must be submitted, beginning with an Applicant ofIntent, together with the associated fee.

REGULATIONS

For complete information regarding registration of an RMD, please refer to 105 CMR 725.100. It is the applicant's responsibility to ensure that all responses are 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 all 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).

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: PM

Siting Profile - Page 2

Application _1_ of_1__

Applicant Non-Profit Corporation Fidelity Wellness Center, Inc.

QUESTIONS

If additional information is needed regarding the RMD application process, please contact the Medical Use of Marijuana Program at 617-660-5370 or RJv1Dapplicationr/i)state.ma.us.

CHECKLIST

The forms and documents listed below must accompany each application, and be submitted as outlined above:

ra A fully and properly completed Siting Profile, signed by an authorized signatory of the applicant non-profit corporation (the

"Corporation")

00 Evidence of interest in property, by location (as outlined in Section B)

l!l Letter(s) oflocal support or non-opposition (as outlined in Section C)

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: _P_M_ _

Siting Profile - Page 3

Application _1_ of_1_

Applicant Non-Profit Corporation Fidelity Wellness Center, Inc.

SECTION A: APPLICANT INFORMATION

1. Fidelity Wellness Center, Inc. Legal name of Corporation

2. Patrick ;f. McGrath

Name of Corporation's Chief Executive Officer

28 Oakville Street, Lynn, MA 01905

3.

Address of Corporation (Street, City/Town, Zip Code)

4. Mario Chiuccariello Applicant point of contact (name of person Department ofPublic Health should contact regarding this application)

5. 978-876-1531 Applicant point of contact's telephone number

6. fidelitywellnesscenter@ Applicant point of contact's e-mail address

7. Number of applications: How many Siting Profiles do you intend to submit? _I_ __

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: _P_M_ _

Siting Profile - Page 4

Applicati.o1 n __ of_l _

Applicant Non-Profit Corporation Fidelity Wellness Center, Inc.

SECTION B: PROPOSED LOCATION(S)

Provide the physical address ofthe proposed dispensary site and the physical address ofthe additonal location, ifany, where

marijuana for medical use will be cultivated orprocessed.

Attach supporting documents as evidence ofinterest in the property, by location. Interest may be demonstrated by (a) a clear legal title to the proposed site; (b) an option to purchase the proposed site; (c) a lease; (d) a legally enforceable agreement to 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 ofbinding permission to use the premises.

Location

Full Address

380 R Dwight Street Building B

1

Dispensing Holyoke, MA 01040

380 R Dwight Street Building B

2

Cultivation Holyoke, MA 01040

380 R Dwight Street Building B

3

Processing Holyoke, MA 01040

Hampden Hampden Hampden

County

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 applicant, and where provided by the applicant, is accurate and complete, as indicated by the initials of the authorized signatory here: _P_ M _

Siting Profile - Page 5

Siting Profile 1 of 1

Fidelity Wellness Center, Inc.

Attachment 1 Section B

Letter of Intent to Lease 380 R Dwight Street, Building B.

----~-

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BINDING LETTER OF INTENT TO LEASE HOLYOKE BUILDING

380R Dwight Street, Holyoke, MA 01040

BUILDING ADDRESS: 380R Dwight Street, Buildiug B, Holyoke, MA 01040

LANDLORD:

Mass Property Partners

TENANT:

380R Dwight Street, Building A, Holyoke, MA 01040 Fidelity Wellness Center, Inc.

28 Oakville St. Lynn, MA

USE:

Medical Marijuana Cultivation, Processing & Dispensing RMD

PREMISES:

Approximately 28 ,500 Square Feet of Industrial Space on approximately .80 acres of land

PRE-APPROVAL TERMS & CONDITIONS

LEASE COMMENCEMENT: Upon Lease Execution.

PRE-LICENSING TERM: 6 months (While obtaining permits & approval from the City of Holyoke):

PRE-LICENSING RENTAL RATE: $250 per month. These payments are non-refundable.

DEPOSIT DUE UPON SIGNING: $5000 DEPOSIT is due upon signing this Letter of Intent and the first months rent. Said payments are non- refundable.

EXCLUSIVITY:

For the consideration paid pursuant to this LOI, Landlord will not offer this property for lease to anyone other than the Tenant during any Period referenced in this LOI.

PRE-LICENSING RENEWAL OPTION: In the event the approval & permitting process extends beyond the 6-month pre-licensing term the Tenant shall have the option to renew for two additional months @ $2000 per month. If the Tenant exercises said option the third (3"' months' rent of the pre-licensing base term shall become non- refundable

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