LOCAL LAWS – Mobile Service Centre Booking Mobile Service Centre Booking This application form is available for organisations whom bring a mobile service van into the region. e.g. Australian Red Cross Blood Service and BreastScreen Victoria * indicates required fieldOrganisationOrganisation* Person responsibleFull name* Address* Phone* Mobile* Email* Booking locationWhere would you like to setup your mobile service van?* Curlewis Street Car Park (opposite Swan Hill Train Station) McCallum Street (Swan Hill Show Grounds) Booking dates and timesHow many visits would you like to book?--OneTwoThreeFourPlease note: On the day of departure, mobile service vans must be collected prior to 7.00am or after 5.30pm due to traffic conditions in the Curlewis car park. Visit oneArrival date* DD slash MM slash YYYY Arrival time* Departure date* DD slash MM slash YYYY Departure time* Visit twoArrival date* DD slash MM slash YYYY Arrival time* Departure date* DD slash MM slash YYYY Departure time* Visit threeArrival date* DD slash MM slash YYYY Arrival time* Departure date* DD slash MM slash YYYY Departure time* Visit fourArrival date* DD slash MM slash YYYY Arrival time* Departure date* DD slash MM slash YYYY Departure time* Public liability insurancePlease upload a copy of your public liability insurance* Drop files here or Select files Accepted file types: jpg, gif, png, pdf, Max. file size: 5 MB, Max. files: 2. Conditions Public Liability Insurance The Organisation shall, at all times during the Agreement Term, be the holder of a current Public Liability Policy of Insurance (“The Public Liability Policy”) to cover legal liability to third parties for personal injury or property damage as a result of an occurrence in connection with the business of the insured, as specified in the public liability policy in the name of the Organisation providing coverage for an amount of at least $20 million dollars. The Public Liability Policy shall extend to cover Swan Hill Rural City Council in respect to claims for personal injury or property damage arising out of the negligence of the Organisation. A current Certificate of Currency must be provided by the Organisation to Council on lodging an Application. Indemnity The Organisation agrees to indemnify and to keep indemnified Swan Hill Rural City 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 them, or any of them, in connection with this Application and be directly related to the negligent acts, errors or omission of the Organisation. Hold Harmless The Organisation agrees to hold harmless Swan Hill Rural City Council, its servants and agents, and each of them in connection with all claims resulting from damage, loss, death or injury whatsoever which may otherwise be brought or made or claimed by the Organisation against Swan Hill Rural City Council, except to the extent that Swan Hill Rural City Council is negligent. AgreementUntitled* I have read and agree to the conditions listed above Untitled* I have authorisation from the above organisation to request this booking Untitled* I acknowledge that the information contained on this application form is true and correct Full name* Position within organisation*
