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Prime Wellness ( >F Connf( Ttcut PRIME WELLNESS ( >F CONNF( TTCUT ApPLICATION FOR A MEDICAL MARIJUANA DISPENSARY FACILITY LICENSE BINDER 1 OF 2 Prime Wellness of Connecticut, LLC www.primewellnessofct.com South Windsor, Connecticut January 28, 2014 Mr. Thomas J. Nicholas, CEO Prime Wellness of Connecticut, LLC 379 Quarry Brook Drive South Windsor, CT 06074 Dear Tom, My understanding is that the CT DCP has asked some of the Dispensary applicants to submit additional information due by February 3, 2014. As such, I'm writing this letter agreeing to the extension of our contingent lease for 75 John Fitch Boulevard, South Windsor, CT 06074 from 1/31/14 to 2/28/14. Hopefully, the department will award dispensary licenses before the end of February. Best of luck in your quest for licensure and please keep me apprised of your progress. Agreed by: . Landlord: Peter Churilo Tennant: Prime Wellness of Connecticut, LLC ( W PRIME WELLNESS l)F CONN ""'CTIClTT ApPLICATION FOR A ( MEDICAL MARIJUANA DISPENSARY FACILITY LICENSE Prime Wellness of Connecticut, LLC www.primewellnessofct.com South Windsor, Connecticut WPRIME WELLNESS (II «)I\;~I( 'II( l 1 ( November, 14th 2013 Via Hand Delivery Department of Consumer Protection Drug Control Division - Medical Marijuana Program RFA #2013-109377 165 Capitol Ave., Room 145 Hartford, CT 06106 Attn: William M. Rubenstein, Commissioner Dear Mr. Rubenstein: Prime Wellness of Connecticut, LLC ("Prime Wellness" ) is pleased to submit for your review and consideration an application for a medical marijuana dispensary facility license. Prime Wellness recognizes the numerous stakeholders involved with this unique project, including but not limited to patients, law enforcement, the medical community, local and State government, and the general public. Given the economic climate, sensitive nature of the industry, and start-up character of the project, Prime Wellness was aware of the many challenges involved in opening a medical marijuana facility. In fairness to all stakeholders, Prime Wellness ( pledged to submit an application only if it was first able to secure in advance matters critical to the viability of a fledging enterprise in a challenging environment - i.e. adequate funding, experienced professionals, site control, etc. Prime Wellness is proud to state that it did successfully secure such matters, and all stakeholders can feel confident that this application does not represent merely an "idea" based on speculative contingencies. Although we are proud of the application submitted for your review, we are even more proud of the individuals who have committed themselves to Prime Wellness' project and its mission and vision of being part of a process that will assist patients to help themselves reach a better quality of life through the availability of pharmaceutical grade medical marijuana and marijuana products; quality education and awareness, and outreach relating to such; trained and knowledgeable professionals and staff members; an atmosphere of compassion, understanding and pride; and proper safety, security and comfort measures. Most respectfully submitted, Chief Executive Officer ( On Behalf of the Prime Wellness Team TABLE OF CONTENTS Tab Ouest. Description 1 A BUSINESS INFORMATION OF ApPLICANT 1 AI. Dispensary Facility License Information Form 2 A2. Qualifications, experience and industry knowledge 3 A3. Financial statement detailing of all business transactions 4 B LOCATION AND SITE PLAN 4 BI. Location of the proposed dispensary facility 5 B2. Documents establishing the applicant is authorized to conduct business in Connecticut and state and local building, fire and zoning requirements and local ordinances are met 6 B3. Statement from the property owner and landlord certifying that they have consented to the applicant 7 B4. Text and graphic materials shown on the exterior of facility 8 B5. Photographs of the sun-ounding neighborhood and businesses 9 B6. Site plan of the facility 10 B7. Map that identifies all places used primarily for religious worship, public or private school, convent or charitable institution 11 B8. Floor plan drawn to scale 11 B8 - a. Location and square footage of the dispensary department 11 B8 - b. Square footage of the areas of the overall dispensary 11 B8 - c. Square footage and location of areas to be used as storerooms or stockrooms 11 B8 - d. Size of counter that will be used for selling marijuana 11 B8 - e. Location of dispensary sink and refrigerator 11 B8-f. Location of approved safes or vaults that are to be used to store marijuana 11 B8 - g. Location of the toilet facilities 11 B8 -h. Location of break rooms and personal belonging lockers 11 B8 - i. Location of patient counseling areas 11 B8 - j. Location where any other products or services will be offered 11 B8-k. Location of all areas that may contain marijuana and marijuana products 12 C PROPOSED BUSINESS PLAN 12 CI. Description of all products intended to be offered 13 C2. Description of all services to be offered Tab Quest. Description 14 C3. Description of the process that the dispensary facility will take to ensure that access to the dispensary facility premises will be limited only to employees, qualifying patients and primary caregivers 15 C4. Description of the features that will provide accessibility to qualifying patients and primary caregivers beyond what is required by the Americans with Disabilities Act 16 C5. Description of the air treatment system that will be installed to reduce off-site odors 17 C6. Description of the process by which marijuana and marijuana products will be delivered to a dispensary facility from the producer 18 C7. Description of the training and continuing education opportunities 19 C8. Description of processes or controls that will be implemented to prevent the diversion, theft or loss of marijuana 20 D PROPOSED MARKETING PLAN 20 Dl. Marketing plan, web templates and educational materials 21 E FINANCIAL STATEMENT AND ORGANIZATION STRUCTURE 21 E Financial soundness and funding sources of the applicant; and appropriateness of credentials, training, qualifications, experience and other matters relating to applicant, backers and key personnel 22 El. Articles of incorporation, articles of association, charter, by-laws, and partnership agreements 23 E2. Organizational chart and resumes 24 E3. Name, title and resume of person who will be responsible for all information security requirements 25 E4. Compensation agreements 26 E5. Forms of indebtedness 27 E6. Audited financial statements for the previous fiscal year or pro forma financials 28 E7. Federal, state and foreign tax returns filed by the applicant 29 E8. Federal, state and foreign tax returns filed by producer backers; 30 F BONUS POINT 30 Fl. Employee Working Environment Plan 31 F2. Compassionate Need Plan 32 F3. Research Plan 33 F4. Community Benefits Plan 34 F5. Substance Abuse Prevention Plan 35 F6. Environmental Plan (( ATTACHMENTS A. Dispensary Facility Location (Question B 1) B. Authorization to Conduct Business and Compliance (Question B2) C. Statement from Landlord or Property Owner (Question B3) D. Text and graphic on the exterior of Dispensary (Question B4) E. Photographs of Neighborhood and Businesses (Question BS) F. Site Plan re: Streets, Property Lines, Buildings, Parking Areas, Etc. (Question B6) G. Map Identifying Religious Worship Places, Schools, Etc. (Question B7) H. Blueprint or Floor Plan of Dispensary Facility (Question B8) I. Security Components (Question C3) J. Marketing Plan Materials (Question D 1) K. Articles of Organization and Bylaws (Question E 1) L. Organization Chart and Resumes (Question E2) M. Compensation Agreements (Question E4) N. Terms of Outstanding Bonds, Loans, Mortgages, Pledges, Notes, Etc. (Question ES) O. Certified Financial Statement of Applicant Since in Existence (Question E6) P. Tax Returns of Applicant (Question E7) Q. Tax Returns of Producer Backer and Those in Section B of Appendix B (Question E8) Z. Safety and Security Plan (Appendix A, Section L) SECTION A. BUSINESS INFORMATION OF APPLICANT QUESTION A.l. Complete the Dispensary Facility In/ormation Form, attached as AppendixA. RESPONSE A.I. Please see the Dispensary Facility License Information Form attached hereto as Appendix A. ( '- PRIME '\' 1:.1 1 LNI::~' / Medical Marijuana Program 165 Capitol Avenue, Room 145, Hartford, CT 06106-1630 0 (860) 7l3-6066 ( E-mail: dcp.mmp{a),ct.gov 0 Website: www.ct.gov/dcp/mmp Appendix A Dispensary Facility License Information Form Section A: Business Information 1. Applicant business type: D Sole Corporation Limited Partnership Limited Liability Unincorporated Other: Proprietorship Liability Co. Partnership Association 2. Legal Name of Applicant: Prime Well ness of Connecticut, LLC 3. Trade Name of Applicant: 4. Applicant's Business Address 06074 5. City: S out h W·In d sor Zip Code: 10. Applicant's Mailing Address (if different than business address): 11. City: Same as business ( 12. State: 13 . Zip Code: 14. Daytime Telephone Number: 15. Fax Number: Section B: Contact InfOl'mation All communications from the department regarding this application will be sent to your primary contact and alternate contact, if one is designated. We will assume that you receive all communications sent to your designated contact(s) and it will be your responsibility to notifY us if any oftheir contact information changes. 16. Name of Primary Contact: 17. Primary Contact Title: Thomas J. Nicholas CEO 18. Primary Contact E-mail ';""IJ"'J11" Number: 20. OPTIONAL - Name of Alternate Contact: John P. Glowik, Jr. 22. Alternate Contact E-mail Telephone Number: Section C: Formation/lncorporation Information 24. Date of Formationllncorporation: 25. Place ofFormationllncorporation: 8/27/13 South Windsor, CT 26. Registered with the COlmecticut Secret3.lY of State: 27. Sale and Use Tax Permit Number: 60335015-001 0Yes DNo Provide a copy of your Sale and Use Tax permit with your application. ~ .~ e ~c.."'~ e 1'7-t- B ( MMP - Dispensary Facility License Application - September 2013 Page 1 of16 Medical Marijuana Program 165 Capitol Avenue, Room 145, Haltford, CT 06106-1630 • (860) 713-6066 E-mail: dcp.mrnpla),ct.gov • W ebsite: www.ct.gov/dcp/mmp Section D: Proposed Dispensary Facility Information 28 .
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