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Certification Of Licensed Health Care Professional - Nyc Department Of Consumer Affairs Page 2

4. The disability impairs the Applicant’s ability to operate a general vending business in the following

manner (please describe with specificity, including the medical facts that support your

certification and attach additional sheets as necessary):

_____________________________________________________________________________

This certification shall be deemed executed in the City and State of New York and shall be governed by

and construed in accordance with the laws of the State of New York (notwithstanding New York choice of

law or conflict of law principles) and the laws of the United States.

By signing below, I certify that the statements above are true and correct.

__________________________________________________

Signature

Print Name

__________________________________________________

Date

A General Vendor Licensee with a disability that impairs the Licensee’s ability to operate a general vending

business may be authorized by the Department of Consumer Affairs to use helpers, as described in Section

2-318 of Title 6 of the Rules of the City of New York.

Definitions:

Disability: a physical or mental impairment that substantially limits one or more major life activities or major

bodily functions and that permanently or temporarily impairs an individual’s ability to operate a general

vending business.

Major life activities: include caring for oneself, performing manual tasks, seeing, hearing, eating, sleeping,

walking, standing, lifting, bending, speaking, breathing, learning, reading, concentrating, thinking,

communicating, and working.

Major bodily functions: include functions of the immune system, normal cell growth, digestive, bowel,

bladder, neurological, brain, respiratory, circulatory, endocrine, and reproductive functions.

Updated 09/22/2016

Certification Of Licensed Health Care Professional - Nyc Department Of Consumer Affairs Page 2