Sidewalk Dining Supplemental Application Page 2 of 3
3. APPLICANT’S CERTIFICATION
1) This license extension allows only the placement of obstructions on the sidewalk in the licensed area as
set forth herein and does not authorize the license holder to serve food or beverages or allow the
consumption of such within the licensed area.
2) This license extension is temporary and only valid while applicable State and City Executive Orders
regarding COVID-19 are in effect.
3) All temporary license extensions to use a public sidewalk for outdoor dining are subject to the standard
conditions and setback requirements found in the Department of Public Works & Parks regulations
pertaining to Outdoor Dining on Public Sidewalks as revised. I have read, and agree to abide by, the
Department of Public Works & Parks regulations and these license requirements (specified on page 3).
4) The Licensee assumes full and exclusive responsibility for compliance with all federal, state, or municipal
laws, rules, orders, regulations, health and safety procedures, or requirements which may be applicable
to the activities conducted on the public right of way pursuant to the Temporary Extension of Outdoor
Dining License issued by the Worcester License Commission.
5) The Licensee agrees to save harmless and indemnify the City, its successors and assigns for any loss,
cost, damage or injury arising or resulting from acts or omissions of the Licensee, its personnel,
employees, agents, invitees, patrons, servants, contractors, subcontractors, and/or representatives in
connection with their use of the public right of way under the Temporary Extension of Outdoor Dining
License issued by the Worcester License Commission.
Name of Authorized Signatory (please print/type)
Title (e.g. Property Manager, Attorney, etc.)
4. EMAIL the supplement application AND the above required attachments to
OutdoorDining@worcesterma.gov to begin the review process.
Applications must be complete to assure timely review and approval. Applications will be reviewed in the order
they are received. Incomplete applications will cause processing delays.
click to sign
signature
click to edit