Change of private contractor application form

CHANGE OF PRIVATE CONTRACTOR APPLICATION

S.138, Roads Act 1993

Application Fee - as per Council's Fees and Charges (this fee is non-refundable once the Private Contractor consent has been issued, even if the works do not proceed by the applicant).

For further information or questions regarding this form, please contact Council via 9911 6555.

Application Details

Type of Application for Change of Private Contractor details: *

Vehicular Crossing LocationRoad Reserve Opening Permit by Private Contractor

Vehicular Crossing Location or Road Opening consent issued by Council

Consent Number: *

Consent Date *

Site Address (This is where works will be undertaken)

Site Address *

Site Suburb *

Site Postcode *

Start date of estimated construction period: *

End date of estimated construction period: *

Applicant Details

Surname *

First Name *

Email *

Contact number: *

Type of applicant *

Property OwnerDeveloperOther

If other, please specify

Company name

Company address *

Suburb *

Postcode *

Contractors Details

Contractors full name: *

Contractors contact number: *

Company name: *

Company mailing suburb: *

Company mailing postcode: *

Company mailing address: *

Current valid copy of the Contractor’s Licence *

Browse

Public Liability insurance *

Browse

I understand that this insurance shall not be cancelled or lapsed without the agreement of Canada Bay Council and the Policy document shall be endorsed to this effect. current copy of the Contractors Public Liability Insurance/ Certificate of Currency to the value of $20,000,000 indemnifying the City of Canada Bay Council MUST be provided.

Owners consent

This application will allow you to apply for consent to do work. Works can only commence once the new Vehicular Crossing Construction OR Road Reserve Opening by Private Contractor consent noting the new Contractor is issued from Council in writing.

Please ensure all property owners sign the owners consent.

Is the owner a company/strata company? *

YesNo

Full Company Name *

Company Owner Signature *