Application to Nominate an Adjudicator
under Section 33 and Section 63
of the Construction Contracts Act 2002
The Claimant requests FairWay Resolution Limited (“FairWay”) as an Authorised Nominating Authority to nominate and request a person to act as Adjudicator for an adjudication under the Construction Contracts Act (2002) (the “Act”) and to administer the procedures in relation to that adjudication. Please ensure that you complete all relevant sections of this application form. The completed application should be emailed to
The application is deemed to have been received by FairWay when all required information has been provided and the relevant fee security amount has been paid. By submitting this form, you are certifying that all of the details provided are correct. Please review your information carefully before submitting.
CLAIMANT DETAILSFull name of Claimant
Trading name (if applicable)
Contact person/
representative
Postal address
Address for service
(if different)
Business/home phone
Mobile
RESPONDENT DETAILS
Full name of Respondent
Trading name (if applicable)
Contact person/
representative
Postal address
Address for service
(if different)
Business/home phone
Mobile
OTHER PARTY DETAILS (if applicable)
Full name of the Party
Postal address
Address for service
(if different)
Business/home phone
Mobile
NOTICE OF ADJUDICATION
Date of Notice of Adjudication
Date Notice of Adjudication was served on the Respondent (see below regarding non-respondent owner)
A copy of the Notice of Adjudication attached to this application?
(Note: this application must be accompanied by a copy of the Notice of Adjudication) / ☐ Yes / ☐ No
Under Section 28(2) of the Act, the Notice of Adjudication must state:
(a) the date of the notice
(b) the nature and brief description of the dispute and of the parties involved
(c) details of where and when the dispute arose
(d) the relief and the remedy that is sought
(e) whether approval for the issue of a charging order under Section 29 is being sought
(f) whether a determination of an owner’s liability under Section 30(a) and an approval for the issue of a charging order under Section 30(b) are being sought
(g) details sufficient to identify the construction contract to which the dispute relates, including:
(i) the names and addresses of the parties to the contract; and
(ii) if available, the addresses that the parties have specified for the service of the notices.
Has the Claimant served on the Respondent any other Notice(s) of Adjudication relating to the same or similar dispute under this construction contract? / ☐ Yes / ☐ NoAPPROVAL FOR THE ISSUE OF A CHARGING ORDER
Does the Claimant seek the Adjudicator’s approval for the issue of a charging order under Section 29 of the Act in relation to the construction site? / ☐ Yes / ☐ No
If yes, does the Claimant seek a determination of liability of a non-respondent owner under Section 30 of the Act? / ☐ Yes / ☐ No
If yes, please state date Notice of Adjudication was served on that non-respondent owner
INFORMATION ABOUT THE CLAIM AND THE PARTIES
Brief description of the matter in dispute
Amount in dispute (excluding GST) / NZ$
INFORMATION ABOUT THE CLAIM AND THE PARTIES (continued)
Subject matter(s) of this dispute / Main issue(s) in dispute / Other issues involved
Amount of money payable / ☐ / ☐
Variations / ☐ / ☐
Extension of time / ☐ / ☐
Delay claims / ☐ / ☐
Damages or liquidated damages / ☐ / ☐
Contra charges / ☐ / ☐
Quality/workmanship / ☐ / ☐
Contract interpretation / ☐ / ☐
Rights and obligations of the parties / ☐ / ☐
Other (specify)
The roles of the parties under the construction contract / The Claimant (select one) / The Respondent (select one)
Commercial owner (including principal, developer, tenant, etc) / ☐ / ☐
Residential owner (including homeowner) / ☐ / ☐
Main contractor (including contractor, head contractor, builder, etc) / ☐ / ☐
Subcontractor (ie employed by main contractor) / ☐ / ☐
INFORMATION ABOUT THE CLAIM AND THE PARTIES (continued)
Sub-subcontractor (ie employed by a subcontractor) / ☐ / ☐
Consultant / ☐ / ☐
Supplier / ☐ / ☐
Other (specify)
EXPERTISE OF THE ADJUDICATOR
Preference for expertise of selected Adjudicator
(Note: FairWay will consider but will not be bound by any stated preference)
Reason for preference
INFORMATION IN ELECTRONIC FORMAT
Do you consent to information being given in electronic form (by email)? / ☐ Yes / ☐ No
FEE SECURITY AMOUNT
The fee security required is 5% of the overall amount in dispute, or a minimum of $5,000, whichever is larger. Payment may be made by direct credit.
(Note: the request to nominate an Adjudicator will not be deemed as received until the fee security is received)
Bank account name: FairWay Resolution Limited
Bank name: Westpac
Bank address: 318, Lambton Quay, Wellington 6011
Bank account number: 03 0502 0287160 00
Swift code: WPACNZ2W (not required for domestic payments)
Payee reference: ANA[your last name] (eg ANASmith)
Amount in dispute (excluding GST) / NZ$Security amount (5% of Amount in Dispute, or $5,000, whichever is greater) / NZ$
AGREEMENT
I confirm that the information I have supplied is true and correct to the best of my knowledge and that I have read and accepted the terms and conditions of FairWay Resolution Limited.
Signature of Claimant / Date
26 August 2015 Page 4 of 7