Before completing, please carefully read the policy and guidance document that accompanies this form.  If you need assistance or have any queries about the form, please call the Tech Support team on (01454) 865859.

A non-refundable fee of £327 is payable upon application, (see Payment section below).

We will not begin to process your application until we have received the application fee.  We will also need a site location plan before we can start processing your application.

Please allow at least ten working days for us to process your application – we will aim to contact you within that time. 

In some circumstances it may be necessary for us to turn down applications because the proposed site is considered to be potentially hazardous.  In these cases, the fee remains non-refundable.

Applicant details

First name:
	
Family name:
	
E-mail address:
	
Telephone number(s):
	
Organisation name, (if applicable):
	
Organisation Address:

	
Your position in the organisation:

Location of proposed item(s)

Please indicate below where the VAS sign(s) is to be placed

Footway:
	
Verge:
	
Other - please specify:
	
Please describe the exact address / location of the site. 

A plan showing the proposed location of the VAS sign is also required to be submitted, along with an up-to-date Street View image or recent photograph.  A precise location for the sign(s) can also be generated via the what3words app: What 3 Words

Description of proposed VAS sign(s) to be placed in the highway

Please describe the apparatus, along with the proposed method of mounting the SLR or SID unit, including the direction it is proposed to face.

Please include any drawings, specification or quotations already obtained from suppliers.

Insurance

You must have a suitable level of public liability insurance to cover this activity. The minimum required is £10m.  Please provide details of your policy.

Name on policy:
	
Insurance company:
	
Policy number:
	
Period of cover:
	
Amount of cover (£m):

Additional Details
Provide any additional information which is required or relevant to your application. (Please attach any additional documents or plans if required).

	

Payment

The non-refundable payment of £327 can be made in the following way:

ONLINE: 	

Visit website at www.southglos.gov.uk to pay using a debit or credit card.
Select ‘Pay Online’.  Then select ‘Other / General invoices’, select ‘Other Payments’ then ‘Design & Operations’ and finally ‘Vehicle Activated Sign (VAS)’.

Declaration
Please read the terms & conditions before signing this application

I am aware of the provisions of the Road Traffic Regulation Act 1984.  I have read the policy and guidance document that accompanies this form and will not occupy the highway until permission is given and licence agreement signed.  The details contained in the application form and any attached documentation are correct to the best of my knowledge and belief.

Signed:
	Print Full Name:
	
Position:
	Date (dd/mm/yyyy):

Contact us

Please return this application by email to: TechSupportStreetcareBMR@southglos.gov.uk

Or by post to the following address:

South Gloucestershire Council
Department of Place
Streetcare & Transport Services
Design and Operations Team
PO Box 1954 
Bristol
BS37 0DD	
T: + 44 (0)1454 865859	
W: www.southglos.gov.uk