Please complete (print) this page and return to the Moyne Shire Council.

Applicant Details

Surname: ______

Given Names: ______

Address: ______P/Code: ______

Telephone (Home): ______(Mobile): ______

Name of Organisation or Club (if applicable): ______

Public Liability Insurance Certificate of Currency Details:

Company Name: ______

Amount Covered: $______

Event Details

Access Ramp will be utilised at: ______Date/s: ______

Event Description (eg festival, concert, meeting etc): ______

No. of persons attending: ______

Hours required (allow for set up and pack up):

From: ______am/pm To: ______am/pm

Ramp Collection and Return

Date to be collected: ______Date to be returned: ______

I hereby make this application for the portable access ramp for the day and the times specified, and I acknowledge having received and read a copy of the Conditions of Portable Access Ramp Use and undertake to be bound by and comply with these Conditions in every respect and I further undertake to be responsible for ensuring that all individuals or groups using the portable access ramp in association with this application shall comply with the Conditions.

Applicant’s Signature:______


MOYNE SHIRE

CONDITIONS OF USE

The Council grants the use of the portable access ramp subject to the following conditions:

Reviewed December 2015

1. APPLICATION

The right to use the access ramp is subject to the Council receiving an application in the required form signed by the proposed applicant undertaking to comply with these conditions. If the proposed user is a club the application must include the personal undertaking by the president and secretary of the club.

2. BOOKINGS

Bookings are considered tentative until receipt of a completed application form and proof of insurance. Tentative bookings will be held for 14 days only.

3. ADULT SUPERVISION

Applicants under the age of 18 years must have the application form completed and signed by an adult who will be supervising the use of the access ramp. The person completing the application form and whose signature appears on the same is subject to these terms and conditions.

4. COUNCIL ACCESS/LIMIT OF HIRE

The Council reserves the right to cancel any booking. If it is necessary to cancel any booking, the Applicant will be advised in writing.

5. OBLIGATION TO INSURE

Applicantsshall, at all times during the term of this agreement, be the holder of a current Public Liability policy of insurance, which covers it in respect of activities relating to the use of Council’s property and be for an amount of at least $20 million. The said policy shall be effected with an insurer approved by Council. Council reserves the right to request proof of such insurance before the commencement of this agreement.

6. INDEMNITY

The Applicant agrees to indemnify and keep indemnified the Moyne Shire Council, its servants and agents, and each of them from and against all actions, costs, claims, charges, expenses, penalties, demands and damages whatsoever which may be brought or made or claimed against then, or any of them, in connection with the use and transport of the access ramp and be directly related to the negligent acts, errors or omission of the Applicant. The Applicant’s liability to indemnify the Council shall be reduced proportionally to the extent that any act or omission of the Council, its servants or agents, contributed to the loss or liability.

7. ACTS AND REGULATIONS
The Applicant shall conform to the regulations of the Health Act, Local Government Act, any Local Law or regulation made there under, and shall be liable for any breach of such Acts or Laws. All other statutory rules, provisions and regulations of the Commonwealth of Australia and State of Victoria must be complied with by the user.
8. CLEANLINESS

The Applicant is responsible for returning the access ramp in a clean and tidy state. Any cost incurred by Council in cleaning the access ramp shall be recoverable from the Applicant.

9. DAMAGES

The Applicant shall accept full financial responsibility for damage to Council property except for normal wear and tear.

10. ASSIGNMENT

Applicants who are granted permission to use the access ramp shall not assign the right of use to any person, organisation or body.

Reviewed December 2015