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Application to Lease or Licence a Council Facility

Complete this online form to apply to lease or licence a Council facility.

To enable Baw Baw Shire Council to process the application, all required information must be attached to this application and all fields marked as 'required' must be completed.

Note: This form is fully compatible for use with Chrome, Firefox and Safari web browsers. Some components are not compatible for use with Internet Explorer.

Section A - Application

1. Date * (required)1. Date * (required)

Open the calendar popup.

2. Name of Applicant * (required)

3. Facility Name (where applicable)

4. Facility Address * (required)

5. Facility Room Number (where applicable)

6. Baw Baw Shire Council Liaison Officer * (required)

7. Rules of Association/Constitution (where applicant is a Not-for-Profit organisation) * (required)

8. A copy of the applicants last audited annual financial report * (required)

9. A copy of all supporting documentation, such as, licenses, registrations, MOU’s, funding agreements, insurance certificates of currency, council etc. * (required)

Please note: Only authorised signatories (persons authorised to sign on the applicants behalf) are permitted to sign this application, by signing this application you are committing your group as the applicant.

You will need to download and execute the signatory page to make your application. The page can be downloaded from the section titled 'Related Information' at the foot of this page.

10. Please attach your executed signatory page * (required)

Section B - Applicant Details

11. Applicant ABN /ACN * (required)

12. Applicant Trading Name (if different from Applicant Name)

13. Registered Legal Entity Address: * (required)

15. If 'other' please specify:

16. Public Liability Insurance * (required)

17. Certificate of Currancy * (required)

Contact Person 1 (Licence)

18. Name * (required)

19. Address * (required)

20. Phone * (required)

21. Email * (required)

Contact Person 2 (Accounts)

22. Name * (required)

23. Address * (required)

24. Phone * (required)

25. Email * (required)

26. What is the Applicant's intended use of this facility? * (required)

27. How will the intended use benefit the community? * (required)

28. Programs – Please detail all programs which are intended to be run from the facility. * (required)

29. Program Schedule * (required)

30. Activities – Please detail all other activities which are intended to be run from the facility * (required)

31. Activity Schedule * (required)

Membership Numbers (If applicable)

32. Total Number of Members

33. Number of Junior Members

34. Number of Senior Members

35. Are members charged a fee?

Yes

36. Junior fee (If applicable)

37. Senior fee (If applicable)

38. Family fee (if applicable)

39. Please detail any other fees charged (if applicable)

40. Intended Operating Hours * (required)

41. What overall percentage of the operating hours will the facility be open to the public? * (required)

42. Will storage be required? If yes, how much space is required? Baw Baw Shire Council makes no guarantee to the provision of storage. (Baw Baw Shire Council makes no guarantee to the provision of storage.) * (required)

43. Is a planning permit required for the intended use? * (required)

44. If not, please attach evidence of same.

45. Is the facility fit for purpose for the intended use? * (required)

46. Does the applicant intend to carry out any alteration or addition to the facility? If yes, please provide details of funding, timeframes, plans * (required)

47. Please attach supporting documents

48. Does the applicant intend to invest funds of a capital nature into the facility? If yes, please provide details of funding, timeframes, and or plans. * (required)

49. Please attach supporting documents

50. Details of additional insurance (if applicable)

51. Please attach additional insurance Certificates of Currancy

52. Is the applicant a not-for-profit organisation under Australian Tax Office definitions? * (required)

yes

53. Is the applicant a legal entity registered under appropriate legislation (such as the Associations Incorporation Act 1981)? * (required)

yes

54. Does the applicant have an Australian Business Number? * (required)

yes

55. Does the applicant comply with all relevant legislation governing its activities and hold all licences and registration certificates required for it to operate? * (required)

yes

56. Does the applicant have a committee or appropriate governance arrangements with established accountability and reporting methods to members of the group and/or to the community? * (required)

yes

57. Has the applicant complied with all terms and conditions of any previous lease/licence agreement, service level agreement or any other agreement with Baw Baw Shire Council? * (required)

yes

58. Is the applicant is currently receiving funding (Grant, subsidy, donation) from Baw Baw Shire Council for this or any other purpose? If yes, provide details: * (required)

yes

59. Funding detail support documents

60. Is there a Service Level Agreement (SLA) or Memorandum of Understanding (MOU) in place regarding the provision of funding or services? If Yes, provide a copy: * (required)

yes

61. SLA or MoU support documents

62. How does the Applicant generate revenue for funding the activity or service it proposes to provide from the facility? (Attach supporting documentation) * (required)

63. Revenue support documents * (required)

64. Is the use of this facility consistent with Council's vision and the goals outlined in the current Council Plan? If yes provide details * (required)

yes

65. Details of consistency with Council vision and goals * (required)

Type the characters you see in the image below * (Required)

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Privacy Statement

The personal information on this form is being collected by Council to enable the distribution of rates and charge details to Ratepayers and the preparation of the Municipal Voters Roll. The information will be used by Council for these primary purposes or directly related to municipal purposes only. Council may disclose this information to other authorities including Gippsland Water, South East Water, TXU, Origin Energy and Telstra to enable the provision of services to the property. If these contact details are not kept up to date, rate notices or other municipal information may not reach you and in the case of Rate Notices, interest and legal charges may be incurred if rates are not paid by the due dates. You may apply to Council to gain access to, or for the amendment of personal information held by Council. Information on Council's Privacy Policies can be obtained from Council's Privacy Officer during business hours on 03 5624 2411.