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Mobile Food Vending Permit Application

2. Permit Holder Name
3. Date
5. Truck/Business Name
6. Email:
8. Business Address
9. Permit Holder Phone Number
11. Is this request for a one-time event or for a monthly spot?
    -- Select One --One Time EventMonthly Spot on West Main Street (by the Subway Station)
12. Requested Start Date
    Requested Start Date

    Requested Start Date
    Your requested start date must be at least 10 days in the future.
14. Operating Hours
    What time will the truck arrive on the island and what time will the truck leave?
15. What type of permit do you current have from the health department?
    -- Select One --ProcessingNon-Processing

    You must have a Mobile Food Unit Vending Permit decal affixed to your pushcart or truck in order to receive a permit for Roosevelt Island.
17. Describe the Goods to be Sold:
19. Drivers License
    Please provide a current drivers license for the person who will be driving the mobile food vehicle.
21. Picture of Unit Decal*
    Please upload a picture of the unit's decal from the health department.
23. Food Handler's Permit*
    Please provide a copy of all current employee food handler photo ID badges.
25. Insurance
    Permit Holder must have a valid copy of insurance coverage (Worker's compensation, disability benefits, employer's liability, commercial general liability insurance (with broad form property damage, productions/completed operations liability, contractual liability, independent contractors, fire/legal liability, property insurance endoresements)/ personal injury
27. Certificate of Liability
    Permit Holder must have a valid certificate of liability that names the following as Additional Insured: RIOC, New York City, New York State, Empire State Development, NY Housing and Community Renewal
29. Permit Holder Agreement

    1. I agree

    By checking off the box above, you agree to adhere to all requirements as stated in Title 17, Chapter 3, Subchapter 2 of the Administrative Code of the City of New York, and attest that the facts stated herein are true, as you reasonably believe.
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31. 1. Receive an email copy of this form.
32. Email address

    This field is not part of the form submission.

33. Submit

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