BUILDER / LANDSCAPER / CONTRACTOR ACCESS TO COUNCILLAND

PERMITAPPLICATION FORM

Please complete and return application form to:

Recreation Services, City of Bayswater, PO Box 467, Morley WA 6943.

Tel. 9272 0662 or email –

______

YOUR ATTENTION TO THE FOLLOWING IS APPRECIATED:

  1. The information you provide on this application form is important. We require accurate information to ensure the equitable access of requested Council land.
  1. An Application does not confirm approval for access. Access is not permitted unless full payment of Permit fees and Bonds has been received by the City of Bayswater, and you have received written confirmation of your Permit approval.
  1. Thisapplication form must be returned to the City of Bayswater no later than 14 days prior to your first access date. Late applications willnot be considered.
  1. Your signature is required on the attached Acknowledgment Form to confirm that you understand and accept the conditions of approval for access to Council land.

Name of Applicant / Builder / Landscaper / Contractor

______

Postal Address:

Suburb: Post Code:

Telephone: (Work)(Home)

Mobile:Fax

Email:

(Please print clearly)

If applying on behalf of a Company / Organisation

Name of Company / Organisation:

______

Position held within Company /Organisation:

______

RESERVE / LOCATION WHEREACCESS IS REQUIRED______

______

______

______

WORKS DETAILS

Please answer the following questions that relate specifically to your access requirements:

Date access required From:______To:______

Nature of the works

Number, type, weight ofvehicles requiring access

______

______

Please provide a brief description of the works to be undertaken

______

Time works commencing & concluding

INSURANCE INFORMATION

Do you or your organisation currently hold Public Liability Insurance?Yes No

If yes, what is the amount of your cover$______million.

Please include a copy of your Certificate of Currency with your completed Application Form.

If no, do you intend to purchase cover before the commencement of works? Yes No

IMPORTANT INFORMATION

  1. AllPersons on Council grounds and reserves are required to comply with all directions that may be issued on the day by an authorised Officer of the City, including Community Rangers;
  1. Persons approved access to grounds and reserves are asked to leave the area free of rubbish and debris at the conclusion of works;
  1. Grounds, gardens and some reserves are public open space and as such no inconvenience or nuisance is to be caused to other users of the City’s grounds, gardens and reserves;
  1. It is the responsibility of the Persons given access approval to ensure that footpaths/bike paths remain in safe and trafficable condition throughout the course of works; and display adequate warning signage;
  1. It is the responsibility of the Persons given access approval to secure the work area to prevent risk to members of the public;
  1. It is the responsibility of the Persons given access approval to ensure a Traffic Management Plan is in place if blocking off footpaths/roadways and provide evidence of such a plan to Council;

HIRE FEES AND BONDS

A $140.00 fee is applicable for issuing a Permit to access Council land.

A $1000.00 Site Bond applies to Access Permit approvals.

A $200.00 Key Bond applies to Access Permit approvals.

Bonds are refunded by cheque within 21 days of return of key and a satisfactory Site inspection by a City of Bayswaterauthorized Officer.

DAMAGE TO SITE

The Person given access approval is responsible for any damage caused on site and all costs involved to undertake repair and reinstatement works to maintain the site in a safe condition, and to return site to standard as existed prior to works.

The Site Bond will not be returned until the repairs are completed, but may be used by the City towards the cost of any repair and reinstatement works.

ACKNOWLEDGEMENT AND ACCEPTANCE

APPLICANT’S DECLARATION:

I have read, understood and accepted the terms, conditions and general information specified in the ‘Builder, Landscaper, Contractor Access Permit Application form' which includes the covering letter received by me, in relation to the access of City of Bayswater land. I agree to comply with the Schedule of Fees and Charges for use that also forms part of these conditions.

Further, I verify that I am in a position to accept these terms and conditions on behalf of the Company/Organisation that I represent. I will to the best of my ability ensure that all associates are aware of the information contained in the specified documents, as well as their responsibilities when accessing the grounds and facilities.

I declare that the information contained in the Builder, Landscaper, Contractor Access Permit Application form'is, to the best of my knowledge true and correct.

NAME OF APPLICANT:

POSTAL ADDRESS:

SIGNATURE: DATE: (Must be 18 years of age or over)