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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