license no 20s...$50. year - jan. 1 - dec. 31 may have entertainment up to 2 times with out a...

LICENSE NO: ___ - 20 __ ISSUED FOR THE PERIOD: ____, 20__, THROUGH _____, 20__.

of 2 Town of Vestal Peddler’s Permit Application Form Revised 10/8/2020

APPLICATION FOR PEDDLING, HAWKING, OR SOLICITING - TOWN OF VESTAL, NEW YORK

$100 DEPOSIT FEE PLUS: FOR UP TO 2 PERSONS ON EACH LICENSE $100.00 PER MONTH FOR UP TO 5 PERSONS ON EACH LICENSE $150.00 PER MONTH FOR MORE THAN 5 PERSONS ON EACH LICENSE $200.00 PER MONTH ANY HAWKER, PEDDLER OR SOLICITOR MAY APPLY FOR A DAILY LICENSE AT A RATE OF $35.00 PER DAY

DATE OF APPLICATION: DRIVERS LICENSE #

APPLICANT'S NAME: LAST FIRST MIDDLE INITIAL

APPLICANT’S ADDRESS:

APPLICANT’S DATE OF BIRTH SOC. SEC. #

LOCAL PHONE HOME PHONE

LOCAL ADDRESS WHERE STAYING _________________________________________________

NAME OF CORPORATION REPRESENTING

ADDRESS OF CORPORATION

KIND OF GOODS TO BE SOLD

TYPE OF SERVICE TO BE PERFORMED

METHOD OF DISTRIBUTION

ADDRESS OF SITE TO BE USED

OUTDOOR BURNING YES ___ NO __ TYPE OF APPLIANCE

LENGTH OF TIME IN OPERATION

DISABLED VET? YES ________ NO ________ STATE ID #

HOW GARBAGE WILL BE HANDLED

BATHROOM FACILITIES HANDLED

NUMBER OF VEHICLES, IF ANY, TO BE USED

LICENSE PLATE: ____________________ MAKE AND MODEL: ___________________



NAME/BIRTH DATE/DRIVER LICENSE/SOCIAL SECURITY # OF ADDITIONAL SALES PERSONS IF APPLICABLE:

LAST FIRST MM/DD/YEAR DRIVER LICENSE # SS #



LICENSE NO: ___ - 20 __ ISSUED FOR THE PERIOD: ____, 20__, THROUGH _____, 20__.

of 2 Town of Vestal Peddler’s Permit Application Form Revised 10/8/2020

ANY KNOWN PAST VIOLATION OF PEDDLERS LICENSE? YES ____ NO _ __

IF YES, EXPLAIN

ONLY ONE SIGN ALLOWED AT SITE INITIAL 15’ SETBACK FROM ROAD INITIAL

NEW YORK STATE SALES TAX # _____ _____ COPY ATTACHED? ______ PROOF OF WORKERS COMPENSATION COVERAGE OR WAIVER ATTACHED? __________

CERTIFICATE OF SEALER OF WEIGHTS’ & MEASURES ATTACHED? YES ____ NO ___

WRITTEN PROOF OF OWNER ALLOWING USE OF PROPERTY LOCATION ATTACHED? _________

FEE $ DEPOSIT $ _______ IF USING HELD OVER DEPOSIT - INITIAL __________

I HEREBY CERTIFY THAT I AM THE APPLICANT NAMED ABOVE AND I CONSENT TO A BACKGROUND CHECK

THAT WILL BE PERFORMED BY THE VESTAL POLICE DEPARTMENT INCLUDING BUT NOT LIMITED TO;

CRIMINAL HISTORY AND DRIVER’S LICENSE SEARCH FOR DOOR TO DOOR SOLICITATION, THE RESULTS

OF WHICH MAY PROHIBIT THE ISSUANCE OF THIS LICENSE. I FURTHER AGREE TO ABIDE BY ALL

CONDITIONS AS PROVIDED IN THE HAWKERS, PEDDLERS, AND SOLICITORS ORDINANCE OF THE TOWN

OF VESTAL.

______________________________ _____________ NAME DATE

FOR TOWN USE:

WRITTEN PROOF TO USE PROPERTY LOCATION ATTACHED? YES____ NO ___

ZONING OF PROPERTY ___ NEAR SCHOOL? YES _____ NO _______

DATE SITE WAS INSPECTED FOR USE __ CODE APPROVAL

DATE SITE WAS INSPECTED AT END OF CODE APPROVAL

SITE PLAN REVIEWED BY TOWN ENGINEER/PLANNING BOARD IF AT SITE MORE THAN 30 DAYS:

YES ___ _ NO ___ _

ANY KNOWN PAST VIOLATION OF PEDDLERS LICENSE? YES ___ NO __

PROOF OF WORKMAN’S COMPENSATION OR WAIVER ATTACHED? YES _____ INITIAL

CERTIFICATE OF SEALER OF WEIGHTS’ & MEASURES ATTACHED? YES _____ INITIAL

FEE $ DATE PAID INITIAL DEPOSIT $ DATE PAID INITIAL

(IF HOLDING DEPOSIT OVER FOR NEXT YEAR INITIAL )

LICENSES & FEES

8/18/2010 NO VENDORS ON TOWN PROPERTY…..

BLOCK PARTIES:(1) REQUIRE LETTER TO BOARD(2) REQUIRES SIGNATURES OF 80% OFPEOPLE ON THE STREET

PEDDLER'S* Good for one month SOLICITOR HAWKERS $100 FOR 2 PERSON + $100 Deposit

$150.00 For 3 to 5 Persons $200.00 For more than 5 Persons

Code Approval is needed. $35 per day

Any duly organized or incorporated local, civic or not for profit corporation may obtain a license for no charge upon presentation to the Town Clerk of proof of same, and license to be effective for no more than 7 days from date of issuance.

*Peddler's go door to door **Solicitor's take orders from customers ***Hawkers sell "stuff" to customers (IE: Hot Dog stand, produce sellers, door to door sales, flowers, Velvet Art.)

NOTE: KIRBY SALES MUST GO BEFORE THE TOWN BOARD FOR APPROVAL…)

PROMOTIONAL $500/MO. Business goes to another property (ie: car dealers to Barnes/Nobel Parking Lot)

TRANSCIENT MERCHANT $250/MO. (Rents space in a bldg. 30 days) (ie: Art Sales @ Holiday Inn, Tool sales at American Legion)

GOING OUT OF BUSINESS $500/ 1 MO. – $50/1 MO. RENEWAL

FOLLOWING CLOSE OF BUSINESS – WE KEEP $75. – THE REST IS RETURNED.

PERMIT FEES AQUIFER $100 REZONING $200 ZBA $ 50

(VARIANCE APPLICATION) SECOND HAND DEALER: $50.00 PER YEAR CARNIVAL $100.00

($50.00 RETURNED IF DENIED)

LIVE ENTERTAINMENT $50. YEAR - Jan. 1 - Dec. 31 may have entertainment up to 2 times with out a license.

MUST PROVIDE: Worker’s Comp. or Waiver, Sales Tax Certificate, Weights and Measures Certificate if applicable

TOWN OF VESTAL Revised10/08/2020

Effective December 20, 2011

CE-200 (12/08)

(Replaces WC/DB-100 and Form C-105.21)

Certificate of Attestation of Exemption from NYS Workers' Compensation and/or Disability Benefits Coverage

Applicants for permits, licenses or contracts from State, county or municipal agencies in New York State that are not required to carry NYS workers' compensation and/or disability benefits insurance coverage.

Please file with the government agency that is issuing the permit, license or contract. (Examples: The New York City Department of Buildings or the New York State Department of Health)

These exemption forms can ONLY be used to attest to a government entity that an applicant requesting a permit, license or contract from that government entity is not required to carry NYS workers' compensation and/or disability benefits insurance. (Instructions)

CE-200 APPLY (2/09)

Used as a paper

application for Form CE-200

which replaces Forms WC/DB-

100 and C-105.21.

Paper application for the CE-200, Certificate of Attestation of Exemption from NYS Workers' Compensation and/or Disability Benefits Coverage

A paper application to obtain the CE-200. The CE-200 is used by the applicant to certify they are not required to carry workers' compensation and/or disability benefits when obtaining a license,permit , or contract from State, county or municipal agencies in New York State.

Applicants using this paper application process may wait up to four weeks before receiving a CE-200. This delay results from Workers' Compensation Board staff having to manually enter information from the applicant's paper application into the web based application.

Accordingly, to avoid delays, all applicants for exemptions are strongly encouraged to use the on-line Form CE-200.

Mail the completed CE-200 APPLY application to:

NYS WCB Bureau of Compliance Form CE-200 100 Broadway Albany, NY 12241-0005 or Fax: 800-486-7175

Once the applicant receives the CE-200, the applicant can then verify the information on the CE-200, sign it and then submit that CE-200 to the government agency from which he/she is getting the permit, license or contract.

Please also print the related instructions for filling out Form CE-200 APPLY (Instructions)

New York State Workers' Compensation

CE-200 EXEMPTION FORM is available at www.wcb.ny.gov FOR AN ON-LINE APPLICATION:

CE-200 (12/08) is an on-line application that allows an immediate print of the exemption form.

Click on On-Line Services – on the right side of the screen.

Then click on Request for WC/DB Exemption and follow the directions.

FOR AN APPLICATION BY MAIL: CE-200 (2/09) is an application which must be printed and mailed/faxed to Albany. The exemption certificate is then mailed to the applicant.

Click on Forms – at the top center of the page.

Click on List of ALL Common Workers Compensation Board Forms.

The forms are in ALPHABETICAL ORDER. Scroll down to CE-200 (2/09) – which is half way down the page.


http://www.wcb.ny.gov/content/ebiz/wc_db_exemptions/wc_db_exemptions.jsp

http://www.wcb.ny.gov/content/ebiz/wc_db_exemptions/wc_db_exemptions.jsp

http://www.wcb.ny.gov/content/main/forms/CE200Instructions.jsp

http://www.wcb.ny.gov/content/main/forms/CE200APPLY.pdf

http://www.wcb.ny.gov/content/main/forms/CE200APPLY.pdf

http://www.wcb.ny.gov/content/main/forms/CE200APPLYINST.pdf

http://www.wcb.ny.gov/

Employers Workers' Compensation Forms

Workers' Compensation Board Forms

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Applicant Instructions for Form CE-200 - Effective December 1, 2008

Form CE-200 reflects a totally new process for granting exemptions from workers' compensation anddisability benefits insurance coverage requirements. Effective December 1, 2008, exemptions will nolonger be valid for multiple permits, licenses or contracts for which the applicant applied. Further,exemptions no longer have to be notarized; nor do they have to be stamped by the NYS Workers'Compensation Board. (Please note that government agencies may continue to use insurance andSelf-Insurance certificates for multiple permits, licenses or contracts issued to a specific legal entityduring the coverage period listed on insurance/self-insurance related certificates).

Starting December 1, 2008, ONLY applicants eligible for exemptions must file a new CE-200 foreach and every new or renewed permit, license or contract issued by a government agency. Each CE-200 will specifically list the issuing government agency and the specific type of permit, license orcontract requested by the applicant. Applicants for building permits will also need to supplyadditional information including identifying the specific job location and the estimated cost of theproject.

Please ensure that the legal entity name on Form CE-200 exactly matches the legal entity name that isapplying for the permit, license or contract. Please also ensure that the applicant signs and dates FormCE-200.

Each CE-200 will have a certificate number printed on it. Form CE-200s may be verified on theBoard's web site at www.wcb.ny.gov.

The applicant attests under penalty of perjury that the infomiation contained in the CE-200 is accurate-the Board does not initially verify this information. However, Board staff may investigate applicantsfiling Form CE-200.

Government agencies have the authority to verify that the business is eligible for the workers'compensation and/or disability benefits exemption reason described on the CE-200 and notify theBoard's investigative staff if there are discrepancies. For example, if you are applying for a license fora 150 seat restaurant and indicate on the CE-200 exemption form that you are a sole proprietor withno employees, this may indicate a problem.

To make this process as easy and as efficient as possible for business owners, the vast majority ofthese forms will be processed electronically on-line. Applicants having access to the internet will beable to fill out the CE-200 on the internet and immediately upon completion, be able to print out ahard copy of the CE-200 that they will then submit to the government agency issuing the permit,license or contract. Computers with internet access will also be available for CE-200 electronicapplication processing at Customer Service Centers located in Workers' Compensation Board DistrictOffices.

Filling out the electronic Form CE-200 on the internet is very similar to filling out a hotel reservationrequest on the internet for frequent travelers. The applicant will create a pin and password so that theycan easily access their information. Once an applicant enters his/her basic information on the Board'sweb site, it can be retrieved by that applicant in the future by using that pin number and passwordwhen the applicant is applying for another permit, license or contract.

Applicants without access to a computer may obtain a paper application for the CE-200 by writing orvisiting the Customer Service Center at any District Office of the Workers' Compensation Board.Applicants using the manual process may wait up to four weeks before receiving a CE-200. Once theapplicant receives the CE-200, the applicant can then submit that CE-200 to the government agencyfrom which he/she is getting the permit, licenseor contract. This delay results from Workers'

http://www.wcb.ny.gov/content/main/fonris/CE200Instructions.jsp 7/17/2013


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license no 20s...$50. year - jan. 1 - dec. 31 may have entertainment up to 2 times with out a...

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