PERMIT APPLICATION

PERMIT FOR BUSINESS USE – ROADS

CHAPTER II, DIVISION 6,

LOCAL GOVERNMENT ACT 1999

Please complete this form in BLOCK LETTERS and return to:

The District Council of Peterborough,

P.O. Box 121,

PETERBOROUGH SA 5422

Telephone(08) 8651 3566

(In this Permit called “the Council”)

APPLICATION:………………………………………………(Your Company’s Name)

Herein called the “Permit Holder”

Of : …………………………………………………………………………………………

Contact Person:………………………………………………………………...………..

Contact Address:…………………………………………………………………………

Contact Telephone:………………………………………………………………………

Make application to use that portion of Main Streetidentified on the attached plan for the purpose ofONE (1)A-Frame Boardfor the period commencing on …………………………………..…………………….(enter date range)in accordance with the General Conditions and the Special Conditions contained in this Permit.

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PERMIT

GENERAL CONDITIONS

The Council grants the Permit Holder a permit under Division 6 of Chapter 11 of the Local Government Act 1999 to use that portion of the street identified on the attached plan (“the area”) for the purpose of a Moveable Sign for the period set out in Special Condition 1.

WHEN THIS PERMIT IS ISSUED:

  1. The Permit Holder agrees to comply with the General Conditions set out in this Permit.
  1. The Permit Holder agrees to comply with any Special Conditions, which are set out in this Permit.
  1. The Permit Holder will pay the fee set out in Special Condition 2 in advance.
  1. The Permit Holder will provide a copy of all certificates, which are required by either the General Conditions or Special Conditions of this Permit.

AND THE PERMIT HOLDER AGREES FURTHER:

1. Indemnifications and Release

1.1The Permit Holder agrees to indemnify the Council from and against all actions, costs, claims and damages, which may be brought or claimed against the Council arising out of or in relation to the granting of this Permit.

1.2The Permit Holder agrees to release the Council from any liability or claim resulting from any accident, damage or injury occurring in the Area.

1.3The Permit Holder agrees that the Council will have no responsibility or liability for any loss or damage to the Permit Holders fixtures or fittings or personal property.

  1. Public Risk Insurance

The Permit Holder must take out and keep current a public risk insurance policy in the name of the Council and the Permit Holder. The policy must insure for the amount of ten million dollars ($10,000,000) and must cover injury, loss or damage to persons or property arising out of the activity carried out under this Permit or the granting of this Permit by the Council.

  1. Disclosure and Evidence of Policy

The Permit Holder must not commence to use the Area until evidence of the public risk insurance policy is given to the Council. The policy must bear an endorsement from the Insurer indicating the Insurer accepts the indemnity given by the Permit Holder.

The insurance policy must also bear an endorsement from the Insurer that it will notify the Council if the premium is not paid or the policy is allowed to lapse or is cancelled.

The Permit Holder must provide the Peterborough District Council with a copy of a Certificate of Currency for Public Liability Cover from their Insurance provider.

  1. Standards

During the period in which this Permit is current the Permit Holder must comply with any applicable industry or health and safety standards in relation to the use of the Area. The Permit Holder must ensure that the activity to be carried out by this Permit is conducted in a safe and responsible manner.

  1. Permit Not Transferable

This Permit is not transferable.

  1. Compliance with Statutory Requirements

6.1The Permit Holder must comply with any Act of Parliament, regulation or by-law relating to the use of the Area.

6.2Wherever there is any cost involved in complying with the preceding requirement, the Permit Holder will be responsible for payment of those costs.

  1. Authorised Use

Not to use or allow the Area to be used for any purpose or activity other than that authorised by this Permit.

  1. Notification of Damage

8.1The Permit Holder must take all reasonable precautions to avoid damage to the Area and any improvements and structures located in the Area. The Permit Holder must immediately notify the Council of damage to the Area or any Council owned property located within or adjacent to the area.

8.2The Permit Holder will be responsible to reimburse the Council for all its reasonable costs to repair or rectify any damage caused as a result of the Permit Holder’s use or misuse of the Area.

  1. Alterations

The Permit Holder may not alter or remove any of the existing fixtures and fittings within the Area nor install any structures or items within or adjacent to the Area without the Council’s prior approval.

  1. Breach

10.1If the Permit Holder breaches a provision of this Permit, the Council may give the Permit Holder written notice to remedy the breach and the notice will identify that failure to remedy the breach will result in cancellation of the Permit.

10.2If the Permit Holder fails to remedy the breach within a time specified in the Council’s notice then, the Council may cancel this Permit.

  1. Execution of Permit

This Permit will not be effective until the Permit holder has received a copy of the Permit signed by the Council.

  1. Contractual Rights Only

This permit does not confer on the Permit Holder any exclusive right, entitlement or interest in the Area.

  1. Interpretation

13.1In this Permit reference to: -

13.1.1“The Council” include it members, employees and agents;

13.1.2“the Permit Holder” include its employees and agents.

SPECIAL CONDITIONS

(1)The Period:One (1) year

(2)The Fee:$ per annum payable at the time of application.

(3)The Permit Holder agrees:

(3.1)To be responsible for and ensure the orderly conduct of members of the public within the Area;

(3.2)Not to cause any disturbances or nuisances to users of land adjacent to the Area or to vehicles or pedestrians travelling along the Main Street;

(3.3)To provide a 1.5 metres clear walkway between the kerb and the nearest A Frame Board;

(3.4)To provide the Peterborough District Council with a copy of a Certificate of Currency for Public Liability Cover from your Insurance provider;

(3.5)To remove the A Frame Board from the footpath at the close of business each day;

(3.6)Must not be placed on a sealed part of any footpath area, unless the sealed part is wide enough to contain the sign and still leave a clear thoroughfare at least 1.2 metres wide;

(3.7)Not within three (3) metres of the corner of a street or road.

I acknowledge that on behalf of the Permit Holder I have read and understand the Permit conditions and on behalf of the Permit Holder agree to abide by the General Conditions and the Special Conditions of the Permit.

……………………………………………… (Company name)

ONE (1) A FRAME PERMIT

FROM …………………………… UNTIL …….…………………… (Date range)

Name ………………………………………………..

Position………………………………………………..

Signature………………………………………………..

OFFICE USE ONLY

PermitApproved

Denied

Insurance Sighted:……………………………………..

Signature:……………………………………..

Position:…………………………………….. Date: / /

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