"Storage Warehouse Self-certification" - New York City

Storage Warehouse Self-certification 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 December 3, 2018;
  • 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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Download "Storage Warehouse Self-certification" - New York City

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NYC SMALL BUSINESS
DCA LICENSING CENTER
SUPPORT CENTER
42 Broadway, Lobby
New York, NY 10004
90-27 Sutphin Blvd, 4th Floor
Monday-Friday: 9:00 a.m.-5:00 p.m.
Jamaica, NY 11435
Wednesday: 8:30 a.m.-5:00 p.m.
Monday-Friday: 9:00 a.m.-5:00 p.m.
Telephone: 311
nyc.gov/dca
STORAGE WAREHOUSE SELF-CERTIFICATION
Name of Applicant:
DCA License Number:
(Fill in if you are renewing;
leave blank if this is a new
license application.)
Premises Address:
(Building Number, Street
Name, Unit, e.g., Floor, Suite,
City, State, ZIP Code)
I certify the following:
1) I am the above Applicant (e.g., sole proprietor) or an owner of the above Applicant (e.g., general
partner, director, corporate officer, or shareholder owning 10% or more of company stock).
2) Applicant will comply with all applicable laws and rules, including:
New York City Administrative Code sections 20-101 – 20-119; 20-475 – 20-483;
20-700 – 20-706; 20-749 – 20-753
Title 6 of the Rules of the City of New York sections 1-01 – 1-19; 2-321 – 2-334;
5-06 – 5-106
3) Applicant will provide to every consumer, without cost to the consumer, legal liability insurance
coverage for loss or damage to the consumer’s property caused by negligence, as defined in the
Uniform Commercial Code (UCC) section 7-204, at the minimum value of $0.30 per pound per
item up to $2,000, and will inform each consumer that the consumer may purchase, through
Applicant, additional coverage to cover specific items or all of the household goods at additional
cost.
By signing below, I certify that the statements above are true and correct.
________________________________________________
________________________________________________
Signature
Print Name
________________________________________________
________________________________________________
Print Title/Position
Date
Updated 12/03/2018
NYC SMALL BUSINESS
DCA LICENSING CENTER
SUPPORT CENTER
42 Broadway, Lobby
New York, NY 10004
90-27 Sutphin Blvd, 4th Floor
Monday-Friday: 9:00 a.m.-5:00 p.m.
Jamaica, NY 11435
Wednesday: 8:30 a.m.-5:00 p.m.
Monday-Friday: 9:00 a.m.-5:00 p.m.
Telephone: 311
nyc.gov/dca
STORAGE WAREHOUSE SELF-CERTIFICATION
Name of Applicant:
DCA License Number:
(Fill in if you are renewing;
leave blank if this is a new
license application.)
Premises Address:
(Building Number, Street
Name, Unit, e.g., Floor, Suite,
City, State, ZIP Code)
I certify the following:
1) I am the above Applicant (e.g., sole proprietor) or an owner of the above Applicant (e.g., general
partner, director, corporate officer, or shareholder owning 10% or more of company stock).
2) Applicant will comply with all applicable laws and rules, including:
New York City Administrative Code sections 20-101 – 20-119; 20-475 – 20-483;
20-700 – 20-706; 20-749 – 20-753
Title 6 of the Rules of the City of New York sections 1-01 – 1-19; 2-321 – 2-334;
5-06 – 5-106
3) Applicant will provide to every consumer, without cost to the consumer, legal liability insurance
coverage for loss or damage to the consumer’s property caused by negligence, as defined in the
Uniform Commercial Code (UCC) section 7-204, at the minimum value of $0.30 per pound per
item up to $2,000, and will inform each consumer that the consumer may purchase, through
Applicant, additional coverage to cover specific items or all of the household goods at additional
cost.
By signing below, I certify that the statements above are true and correct.
________________________________________________
________________________________________________
Signature
Print Name
________________________________________________
________________________________________________
Print Title/Position
Date
Updated 12/03/2018