Application form -– ACTBicycleLockers

Touseabike locker, pleasecompletethisformandmailor emailittotheaddressbelow. Once we receive your completedform,youwillbeplacedona waiting list. You will be notified once a locker becomes available.

Please note that you must renew your access to the bicycle annually. If no notice of renewal is received, the locker will passto the next person on the waiting list.

Manager (Bicycles)

Roads ACT – Road Maintenance

PO Box 777

FYSHWICK ACT 2609

Email:

Name: ...... Surname: ...... (locker-user)

Street address: ......

Suburb: ...... Postcode: ......

Telephones:(H) ...... (W) ...... (M)......

Email: ......

Bike locker number: ______(this must be filled in – initial of suburb + number eg. C8)

Thisagreement expires on31 December 2017

Location: (please tick the location)

Belconnen Bus Station (corner of Cohen and Josephson Street)

City: Mort Street(corner of Bunda Street)

Gungahlin: Northern side of Hibberson Street(east of Gozzard Street)

Mitchell: Flemington Road (opposite Exhibition Park)

Tuggeranong: Southern side of Pitman Street(west of the bus interchange)

Woden: Northern side of Bowes Street(west of Callam Street)

Conditions of use –bicycle lockers

The lockerswillbe madeavailable tothe public onthe following conditions:

  • The use of bicycle lockerisfree of charge.
  • Onlyone locker (throughoutthe ACT),willbe issuedper person.
  • Agreementperiodscommence when the locker-user signsthe Usage Agreement. The term ofthe agreementwillbe for periodsof up to12months.Agreementswill expire on 31December each year. Thiswillbe written on the Usage Agreement.
  • The locker-user willneedtosupplya suitable padlocktosecure the locker.
  • No one,other than person named on the agreement,istouse the locker.
  • The locker-user willnotstore anythingin the locker other than abicycleand helmet.
  • The locker-user willkeepthe insideof the locker clean andclear of rubbish;and willalwayskeepthe locker lockedexcept when present.
  • Prior tothe expirationofthe Usage Agreement,the locker-user willreceive a renewal application form. If the locker-user wishes to continue to use the locker, this form must be completed and returned by 12 December of each year for the following year.
  • If the agreementisnotrenewedbythe expiration date or no notification of intent not to renew has been received,Roads ACTwill attempt tocontactthe locker-user by phone or email and give notice of cancellation.
  • If the Usage Agreementisnotrenewedwithin 14daysafter the expirationdate, the contentsofthe locker willbe removedandthelockschanged.The contents removedfrom locker willbe stored at255Canberra Avenue Fyshwick for threemonths prior todisposal.
  • If the locker-user no longer wishes to use the locker, s/he should contact Access Canberraon 132281 andarrange for theagreementtobe cancelled. The locker-user mustremove everythingfrom the locker within14 days after expiryor cancellation of the agreement.
  • Roads ACTisnotliable for anylossordamagetoitemsstoredinthe locker.
  • Roads ACThasthe righttoarrange for the locker tobeopenedfor inspection or maintenance with sevendaysnotice.
  • Damage tothe locker shouldbe reportedimmediatelytoAccess Canberraon 132281.

Personswhodonotcomplywiththese Conditions of Use willhave their Agreement terminatedimmediatelyandthe locker willbe re-allocated.The person will be given sevendaystoremove items from the locker. Otherwise, the contents of the locker will be removed and the locks changed. The contents removed from locker will be stored at 255 Canberra Avenue Fyshwick for three months prior to disposal.

I agree to abide by the Bicycle Locker Conditions of Use.

Signature:……………...... … Date: ......

RMS PO Box 777 Fyshwick ACT 2609  Telephone (02) 6207 6682  Facsimile (02) 6213 0769