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Contractor List Request Form

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Firebreaks/Slashing/Mitigation Contractor List Request Form

All fields are required except where indicated

Contractor to complete items 1.0 to 5.0

The onus rests with the contractor to ensure that the information they provide is TRUE and CORRECT.

You must be a registered business to complete this submission.

1.0 Company Details

You must be a registered business to fill out this submission
1.3 Does GST apply to your Business? :

1.4  Address of Company

Note: street number and street name are needed for all addresses

Postal Address details (optional)

Primary Contact

1.5 Are you a local business to the City of Cockburn:
Please check the attached list of boundary zones to determine if you fall into this category - Local Business Zones
1.6 Do you service all suburbs within the City of Cockburn?:

2.0 Nature of Business

Main Business Activity:





3.0 Insurances

Does the organisation have / make available the applicable insurances?:




4.0 Conflict of Interest

Please Note: Any association with a City of Cockburn representative must be disclosed, this includes City employees, authorised agents and Elected Members. You must acknowledge, and agree to comply with, any approach identified in this form for removing or managing an actual, perceived or potential conflict of interest. The City requires all employees to notify their supervisor and declare any potential conflicts that exist between suppliers and themselves.
Do you or any personnel at your organisation believe you have an existing or perceived association with a City of Cockburn representative that may cause a Conflict of Interest?:

If you answer yes to the above question, please follow the procedures set out in the: Conflict of Interest Form 

5.0 Terms and Conditions

Declaration:

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Contact

Address

City of Cockburn
Whadjuk Boodjar
9 Coleville Crescent,
Spearwood 6163

PO Box 1215, Bibra Lake DC,
Western Australia, 6965

Office opening hours:
8.30am to 4.30pm
Monday to Friday (excluding public holidays)

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Cockburn Nyungar moort Beeliar boodja-k kaadadjiny. Koora, yeyi, benang baalap nidja boodja-k kaaradjiny.
Ngalak kaditj boodjar kep wer kaadidjiny kalyakool yoodaniny, wer koora wer yeyi ngalak Birdiya koota-djinanginy.

The City of Cockburn acknowledges the Nyungar people of Beeliar Boodjar. Long ago, now and in the future they care for Country.
We acknowledge a continuing connection to Land, Waters and Culture and pay our respects to Elders, past and present.