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- "Request for Authorization to Use a General Vendor Helper" - New York City
"Request for Authorization to Use a General Vendor Helper" - New York City
Request for Authorization to Use a General Vendor Helper is a legal document that was released by the New York City Department of Consumer Affairs - a government authority operating within New York City.
Form Details:
- Released on September 22, 2016;
- The latest edition currently provided by the New York City Department of Consumer Affairs;
- Ready to use and print;
- Easy to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a printable version of the form by clicking the link below or browse more documents and templates provided by the New York City Department of Consumer Affairs.
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2REQUEST FOR AUTHORIZATION TO USE A
42 Broadway
New York, NY 10004
GENERAL VENDOR HELPER
Dial 311
(212-NEW-YORK)
You can request to use helpers to operate your business if you have a
“disability” that impairs your ability to operate your general vending business,
nyc.gov/dca
as described in Section 2-318 of Title 6 of the Rules of the City of New York.
Definitions:
Disability: a physical or mental impairment that substantially limits one or more
major life activities or major bodily functions and that permanently or
temporarily impairs an individual’s ability to operate a general vending
business.
Major life activities: include caring for oneself, performing manual tasks,
seeing, hearing, eating, sleeping, walking, standing, lifting, bending, speaking,
breathing, learning, reading, concentrating, thinking, communicating, and
working.
Major bodily functions: include functions of the immune system, normal cell
growth, digestive, bowel, bladder, neurological, brain, respiratory, circulatory,
endocrine, and reproductive functions.
Applicant Name:
License Number
(if applicable):
Home Address:
I certify the following:
1. Please select the statement that describes you (check one box):
I am a new applicant.
I am a current licensee.
2. I have a disability that impairs my ability to operate my general vending
business and have attached the Certification of Licensed Health Care
Professional confirming this disability.
09/22/2016
REQUEST FOR AUTHORIZATION TO USE A
42 Broadway
New York, NY 10004
GENERAL VENDOR HELPER
Dial 311
(212-NEW-YORK)
You can request to use helpers to operate your business if you have a
“disability” that impairs your ability to operate your general vending business,
nyc.gov/dca
as described in Section 2-318 of Title 6 of the Rules of the City of New York.
Definitions:
Disability: a physical or mental impairment that substantially limits one or more
major life activities or major bodily functions and that permanently or
temporarily impairs an individual’s ability to operate a general vending
business.
Major life activities: include caring for oneself, performing manual tasks,
seeing, hearing, eating, sleeping, walking, standing, lifting, bending, speaking,
breathing, learning, reading, concentrating, thinking, communicating, and
working.
Major bodily functions: include functions of the immune system, normal cell
growth, digestive, bowel, bladder, neurological, brain, respiratory, circulatory,
endocrine, and reproductive functions.
Applicant Name:
License Number
(if applicable):
Home Address:
I certify the following:
1. Please select the statement that describes you (check one box):
I am a new applicant.
I am a current licensee.
2. I have a disability that impairs my ability to operate my general vending
business and have attached the Certification of Licensed Health Care
Professional confirming this disability.
09/22/2016
3. My disability is (check one box):
Permanent
Temporary
If your disability is temporary, DCA may require you to submit supplemental medical reports or
certifications to verify the continued existence of your disability.
Important: You must be physically present in order for your helpers to operate your general vending
business. If you will be temporarily absent from your vending display, you must cover the vending display
so that customers know that your display is closed for business. You may receive a violation for
unlicensed activity if a helper is at your uncovered vending display while you are not at the display.
I understand that DCA has not yet considered this request. I will not use helpers until I receive
authorization from DCA. This certification shall be deemed executed in the City and State of New York
and shall be governed by and construed in accordance with the laws of the State of New York
(notwithstanding New York choice of law or conflict of law principles) and the laws of the United States.
I understand that falsification of any statement made herein is an offense punishable by a fine or
imprisonment or both, and may result in the denial of my request or, if granted, revocation of DCA’s
authorization to use helpers. By signing below, I certify that the statements above are true and correct.
__________________________________________________
__________________________________________________
Signature
Print Name
__________________________________________________
Date
09/22/2016
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