Indicates required field Collection of Information Colac Otway Shire is committed to protecting your privacy. The personal information requested on this form is being collected by Colac Otway Shire for the purpose of an Application to Spruik in a Public Place and other related purposes. The personal information may also be disclosed to Local Laws, Risk and OHS, Emergency Management, Health Protection, Building, and Statutory Planning departments for the purpose of assessing if further approvals may be required for the event. It will not be disclosed to any other external party without your consent, unless required or authorised by law. If the personal information is not collected, the application for a permit cannot proceed. If you wish to alter any of the personal information you have supplied to Colac Otway Shire, please contact Council via telephone on 5232 9400 or email inq@colacotway.vic.gov.au. Council’s Privacy Policy is available from our website: colacotway.vic.gov.au/Council-the-shire/Council-policies and all Council Customer Service Centres. Fees Apply Fees info Permit fee $110.00* *Fee waived for registered charitable organisations. Your Details First name Last name Residential or postal address Best phone number to contact you on Email Application Details Description of activities Age of performer(s) Persons under-16 years of age must be accompanied by a parent or guardian. Number of performer(s) Type of instrument/s (if applicable) Start Date End Date Start Time End Time date validation Update Has permission been obtained from the surrounding businesses? Yes No Public Liability Insurance Please ensure that the following information is attached with this application.Applicant’s Public Liability Policy Certificate of Currency noting Colac Otway Shire Council as an interested party (with proof of a minimum $20 million Public Liability Insurance coverage) attached. Please be advised that it is the applicant’s responsibility to ensure that your insurance policy covers the activity or event relevant to the application. Public Liability Insurance Certificate Upload Attach Certificate of Currency noting Colac Otway Shire Council as an interested party (minimum $20 million coverage) Upload requirementsOne file only.20 MB limit.Allowed types: pdf, doc, docx. Proceed to Payment Leave this field blank