facility hire agreement cressy community centre - Northern Midlands ...

I hereby make application for premises set out in the above Schedule to this application for the day and the
times specified above. I acknowledge having received and read a copy of the Conditions of Hire of
Council Facilities and having read and accepted the above insurance conditions undertake to be bound
by and comply with these Conditions in every respect. I further undertake to be responsible for ensuring
that all individuals or groups using the premises in association with this application shall comply with the
conditions.
I (please print full name) ______________________________________________of (please print address)
______________________________________________representing (please print name of organisation if
applicable) ___________________________ as hirer of the CRESSY COMMUNITY CENTRE facility on
____/_____/_____ acknowledge having read and accepted the conditions of hire.
Signed: ____________________________
Date: _____/_______/_____
Please note that this form is to be returned to the Management Committee / Person
of the above facility not to Council directly, failure to do so may result in your
booking not being processed.
IMPORTANT INFORMATION:
1. The following activities cannot be covered by Council’s blanket public
liability policy:
• Sporting Events
• Markets/Fairs
• Contractors/Sub-Contractors • Special Events (i.e. dances, shows,
festivals, etc.)
2. Casual hirers are advised that Council’s Casual Hire Insurance does not
cover persons who are working for hire or professional persons who
generate an income from the event.
3. Insurance details
Policy Number:
Insurance:
Class:
QM2367-1109
QBE Broadform Liability
Casual Hirers
Period of Insurance: 30 June 2014 to 30 June 2015 at 4.00pm
Insurance Broker:
Marsh Pty Ltd
for a copy of the policy document contact Council on phone no. 6397 7303 or
email council@nmc.tas.gov.au
Facility Hire Agreement Form
2
Northern Midlands Council