Fill - Free fillable YOU MUST SUBMIT YOUR APPLICATION AT LEAST 2 (City of Troy, NY) PDF form

Office of the City Clerk

433 River St, Suite 5001

Troy, NY 12180

(518) 279-7134

YOU MUST SUBMIT YOUR APPLICATION AT LEAST

2 WEEKS BEFORE THE EVENT

Contact Person:

Phone #: Email:

Business Name:

Mailing Address:

Type of Event: ÿ Block Party ÿStreet Festival ÿParade ÿOther:

Name of Event:

Date of Event: Hours:

Describe Items Being Sold:

Are you selling food/beverages? ÿ No ÿ Yes (Attach Rensselaer County Health Dept. Certification)

Name of Insurance Carrier:

Applicant’s Signature: Date:

Attach to your application (see next page for information):

1) $20 processing fee

2) Background check form

3) Certificate of Insurance naming the City of Troy as an additional insured

4) Proof of worker’s compensation insurance or that no worker’s compensation is required

5) Rensselaer County Health Department Certification for food/beverage vendors

Your application will not be processed until all paperwork has been submitted.

Office Use Only

Chief of Police: Date:

Deputy Mayor: Date:

(seal)

City Clerk: Date:

ONE DAY VENDOR

PERMIT

One-Day Vendor Permit Fees, Insurance Requirements, and Rules

1. Permit Fee

There is a non-refundable processing fee of $20, payable by cash, check or money order. Make

checks payable to Troy City Clerk.

2. Background Check

One-Day Vendors are exempt from fingerprinting requirement.

3. Certificate of Liability Insurance.

During the term of any permit, the permit holder shall carry liability insurance naming the City of

Troy as an additional named insured for the period covered by the permit.

The following insurance coverage amounts shall apply:

· $1,000,000 Each Occurrence

· $2,000,000 Aggregate

· $1,000,000 Products and Completed Operations

· $2,000,000 Products and Completed Operations Aggregate

· $1,000,000 Advertising and Personal Injury Liability

If alcoholic beverages are served and/or sold:

· $1,000,000 Liquor Liability

Umbrella Liability $1,000,000 to $5,000,000 – amount determined by the type of event at the

discretion of the Corporation Counsel

Refer to the sample Certificate of Insurance on the following page.

4. Proof of Worker’s Compensation.

New York State law requires that you submit either proof of workers’ compensation/disability

insurance (Form C-105.2) or proof of exemption (Form CE-200). Go to http://www.wcb.ny.gov/

for more information. Note: you must submit one of these forms; a written statement is not

acceptable.

5. Food/Beverage Vendors

If you are preparing, processing, or cooking food on site, you must obtain a one-day permit from

the Rensselaer County Department of Health. Please call them at 518-270-2711 or 518-270-

2655, or email mgwynn@rensco.com.

ACORD

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



NAME CITY OF TROY AS ADDITIONAL INSURED. CERTIFICATE HOLDER IS NOT ADEQUATE.

CHECK POLICY >

DATES AND >

AMOUNTS >

YOUR NAME/BUSINESS NAME

(Include DBA if relevant)

UMBRELLA LIABILITY MAY BE

REQUIRED BY CITY OF TROY

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YOU MUST SUBMIT YOUR APPLICATION AT LEAST 2 (City of Troy, NY)

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