NATIONAL WASTE COLLECTION PERMIT OFFICE

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1 OFFALY COUNTY COUNCIL AS THE NATIONAL WASTE COLLECTION PERMIT OFFICE NEW Waste Collection Permit Application Form & Waste Collection Permit REVIEW Application Form Applicant Name: Telephone Number: Postal Address: IMPORTANT Please note this application form is continuously updated. If you have not recently received/downloaded this form, you are advised to contact the National Waste Collection Permit Office to confirm that this is the most recent version. Version 2.2

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3 CONTENTS 1. GENERAL Introduction Who do I Apply to? Fees Payable Pre-Application Consultation Guidance on the Application Form Additional Documents to be Included About these Guidance Notes 3 2. WASTE COLLECTION PERMIT APPLICATION FORM Application Type Existing Permit Holders Consultant/Agent 5 SECTION A - Waste Collection Permit REVIEW Form 6 SECTION B - About the Applicant 8 SECTION C - About the Waste Collection Activity 12 SECTION D - Additional Information 18 APPENDICES 19 Appendix 1 - Statutory Declaration 19 Appendix 2 - Suggested Newspaper Notice Format 20 Appendix 3 - Question B.8 Financial Commitment Discharge Declaration 22 Appendix 4 - Question B.9 Motor Vehicle Insurance Declaration 23 Appendix 5 - Question B.9 Public Liability Insurance Declaration 25 Appendix 6 Question 2.2 Declaration for Revocation of Single Region Permit 27 Appendix 7 - Checklist of Information 28

4 Part 1 General 1. GENERAL 1.1. Introduction On the 1 st of February 2012, Offaly County Council was designated as the Nominated Authority for the processing of all new Waste Collection Permit applications and Review applications received on or after that date. This single Nominated Authority will be known as the National Waste Collection Permit Office (). This form is for the following purposes under the Waste Management (Collection Permit) Regulations S.I. No. 820 of 2007 and the Waste Management (Collection Permit) Amendment Regulations S.I. No. 87 of 2008 (hereafter referred to as the Regulations); the making of an application for a: single region waste collection permit; or multi region waste collection permit; or review of a waste collection permit instigated by a Nominated Authority; or review of a waste collection permit instigated by the permit holder. A guidance manual is available to download on the Environmental Protection Agency web site and the application form and guidance manual is available to download from the web site In order to make the application process as efficient as possible, it may be necessary for the to contact the applicant or a representative for the applicant while processing the application. The application contact person must have a good knowledge of the application form and the detail within. For this reason it is recommended that the application contact person should be the person who has completed the application form and any relevant supporting information Who do I Apply to? All Waste Collection Permit applications and Waste Collection Permit Review applications made on or after the 1 st of February 2012 shall be made to the National Waste Collection Permit Office. Address NATIONAL WASTE COLLECTION PERMIT OFFICE - CONTACT DETAILS Offaly County Council Áras an Chontae Charleville Road Tullamore Co. Offaly Telephone Fax Website 1

5 Part 1 General 1.3. Fees Payable New Application Fees Review Fees Single-Region Permit 1, Multi-Region Permit Payment Method Credit Transfer or Direct Lodgement Postal Money Order or Bank Drafts Cash, Cheque, Credit or Debit Card 1,000 per region, up to a maximum charge of 5,000 for all regions. Instruction Lodge to Offaly County Council s Bank Account: Bank of Ireland, Bridge Street, Tullamore, Co. Offaly. Sort Code: Account Number: per region up to a maximum charge of 2,500 for all regions. PLEASE QUOTE CODE AND INCLUDE YOUR NAME Crossed and made payable to Offaly County Council. Pay at the Cash Office in Offaly County Council, or pay with credit or debit card, over the phone. Phone Offaly County Council on Pre-Application Consultation It is recommended that pre-application consultations or discussions with the are undertaken before a formal submission of any of the above types of applications. It is also recommended that the applicant familiarise themselves with the application form and Regulations and Bye-Laws (Skip Bye-Laws, Household Waste Bye-Laws for example) before beginning to complete the application. In addition, applicants need to be aware of the requirements of the relevant Waste Management Plan/s for the region or regions and the National Hazardous Waste Management Plan Waste Management Plans are available to download from all local authority websites. The National Hazardous Waste Management Plan produced by the EPA, is available at Guidance on the Application Form The contents of an application and the information to accompany an application are specified in Articles 6 and 7 of the Regulations. The may request a waste collection permit holder under Article 23 of the Regulations, to review a collection permit. A waste collection permit holder may submit an application to the to review a permit under Article 24 of the Regulations. Both an application for a new permit or a review of an existing permit shall be made in accordance with the requirements of Articles 5, 6 and 7 of the Regulations. 2

6 Part 1 General The application form is designed in such a way as to set out questions in a structured manner and not in the order presented in the Regulations. All sections in this application form may not be relevant to every application, or applicant. However, the applicant should look carefully through the complete form and provide all relevant information. If any question is considered 'not applicable this should be stated in full. The use of the abbreviations (e.g., N.A. or dash) should be avoided. Additional attachments may be included to supply any further information supporting the application. Attachments should be clearly numbered, titled and paginated and must contain the required information as set out in the application form. Consistent measurement units must be used throughout the application form Additional Documents to be Included Documents and information which must be supplied with the application are presented as a checklist in Appendix 7 of this application form. The applicant is advised to complete the checklist and submit with the application. Any applicant who does not submit all of the relevant documents will be contacted by the to supply the missing documents within a set timescale. For new applicants, please ensure that you have attached a copy of the newspaper notice with your application (a copy of the page of the newspaper). You are required to submit details in relation to the waste types and quantities you will be collecting as per question C.3 of this application. The required template is available to download at in the form of an excel spreadsheet. It is recommended that this is completed electronically and submitted on a CD with the application About these Guidance Notes These guidance notes have been developed to assist applicants in the preparation of an application for a single region or multi region waste collection permit or a review of collection permits under the Regulations. This document does not purport to be and should not be considered a legal interpretation of the provisions and requirements of the Waste Management (Collection Permit) Regulations S.I No. 820 of 2007 and the Waste Management (Collection Permit) Amendment Regulations S.I No.87 of While every effort has been made to ensure the accuracy of the material contained in this document, the assumes no responsibility and gives no guarantees; undertakings or warranties concerning the accuracy, completeness or up-to-date nature of the information provided herein and does not accept any liability whatsoever arising from any errors or omissions. 3

7 Part 2 Waste Collection Permit Application Form 2. Waste Collection Permit Application Form 2.1. Application Type Please tick the relevant box to which this application applies. (Only one box may be ticked). New waste collection permit (go to Section B ) Review of a waste collection permit or permits which has been initiated by the nominated authority (go to Section A ) [Article 23 (1) & (2)] Review of a waste collection permit or permits which has been initiated by the permit holder (go to Section A ) [Article 24 (1) & (2)] NOTE: An application for the review of a waste collection permit granted under the 2008 Regulations (as amended) must be made no later than 60 working days before the expiry date of the permit, if it is to remain in force. [Article 24 (1)] Existing Permit Holders If you are a holder of existing waste collection permit(s), please complete the table below. Please complete the Revocation of Single Region Waste Collection Permits declaration document contained in Appendix 6, where applicable. Nominated Authority Permit Number Please include a current copy of each existing waste collection permit. ATTACHED 4

8 Part 2 Waste Collection Permit Application Form 2.3. Consultant/Agent Is the application being completed by a Consultant/Agent? Yes No If yes, give the Consultant s/agent s name, address and contact details below. Contact Name Address Telephone Fax Should all correspondence be sent to the agent s address (where applicable)? Yes No NOTE: If the answer is No, all correspondence will be sent to the applicant s address. 5

9 Section A Waste Collection Permit Review Form SECTION A - WASTE COLLECTION PERMIT REVIEW FORM Section A is for REVIEW applications ONLY. A.1 Reason(s) for Review Please tick the relevant reasons why a review has either been initiated by the nominated authority or permit holder and provide brief explanation. (Complete one table only). Where a Nominated Authority has initiated Review [Article 23 (1) & (2)] Reasons for Review: The has determined that the there has been a *significant change in nature, focus or extent of waste collection activity. [Article 33] At the request of another Local Authority. Amendment to the Waste Management Plan for the region. Other (please specify below). Explain reason for review (continue on separate sheet if necessary) and provide copy of Notice from nominated authority. [Article 23 (3)] Document(s) Reference: Where a Permit Holder has initiated Review [Article 24 (1) & (2)] Reasons for Review: The permit holder has determined that there has been a *significant change in nature, focus or extent of waste collection activity. Holds a number of individual permits and wishes to make one application and to extend waste collection activities. Other (please specify below). Explain reason for review (continue on separate sheet if necessary). Document(s) Reference: *NOTE: When an application for a review has been submitted due to a significant change in nature, focus or extent of waste collection activity, the may determine that a new application is warranted (please see examples on the following page). 6

10 Section A Waste Collection Permit Review Form For example, in the following circumstances a new application is generally required: Where an applicant wishes to collect hazardous waste, but currently only has a permit for non-hazardous waste collection. Where an applicant wishes to collect door-to-door household waste, but does not currently hold a permit to collect this waste type. Where an applicant wishes to add more regions to their permit. Where there is a change in legal entity of permit holder (e.g. change from sole trader to limited company). For example, in the following circumstances a new newspaper notice is generally required: Where the applicant wishes to add more local authority areas within a current granted region. Where the applicant proposes to collect new waste types which weren t previously advertised. Where applicants have concerns that their review application may be considered as a significant change, they are advised to engage in the pre-application consultation process. A.2 Consultation with a Nominated Authority If you are applying for a review of a single region or multi-region waste collection permit, have you had any form of consultation with a nominated authority? Yes No Please include any form of correspondence that may have been received from the Nominated Authority or details of the consultation or contact name and telephone number of the Nominated Authority representative. ATTACHED Contact Name Telephone Pre-Consultation Reference 7

11 Section B About the Applicant SECTION B - ABOUT THE APPLICANT B.1 Full Name of Applicant(s) [Article 7 (1) (a)] Applicant(s) must be a legal entity (sole trader, partnership or body corporate). In the case of joint applicants, identify the principal applicant. Name(s) Name(s) B.2 All Trade Name(s) used or proposed to be used by the Applicant(s) [Article 7 (1) (b)] Trade Name Trade Name Attach a copy of your Certificate of Business Name from the Companies Registration Office. ATTACHED B.3 Full Address of Applicant(s) [Article 7 (1) (c)] The address of the principal place of business, or in the case of a body corporate the registered or principal office of the applicant(s) and the telephone number and address of the applicant(s). Address Telephone Fax * Contact Name *NOTE: A valid address must be provided with the application. 8

12 Section B About the Applicant B.4 Is the Applicant a Body Corporate? [Article 7 (1) (e)] Yes No If yes, please attach a copy of the Certificate of Incorporation. ATTACHED If the applicant(s) is a body corporate, please give the name and address of any person who is a director, manager, company secretary or other similar officer of each body corporate. [Article 7 (1) (e)] Name, address and position Name, address and position Name, address and position Name, address and position Name, address and position Please attach a copy of the company printout from the Companies Registration Office detailing the company directors. ATTACHED 9

13 Section B About the Applicant B.5 Is the Applicant(s) a Partnership? [Article 7 (1) (d)] Yes No If the applicant is a partnership, give the names and addresses of all partners. Name and Address Name and Address Name and Address B.6 Relevant Convictions/Court Order [Article 7(1) (k)] Has the applicant, including in the case of a body corporate any officer of that body corporate, been convicted of any offence, prescribed under the Waste Management Act 1996, the Environmental Protection Agency Acts 1992 and 2003, the Local Government (Water Pollution) Acts 1977 and 1990 or the Air Pollution Act 1987 and article 21 of the Waste Management (Collection Permit) Regulations S.I No. 820 of 2007 and the Waste Management (Collection Permit) Amendment Regulations S.I No 87 of 2008, within the previous 10 years? [Article 7(1) (k) & (l)] Yes No If yes, please include a supplementary sheet detailing the court hearing, the case, nature of the offence and any penalty or requirements imposed by the court. Where there is more than one offence to be considered, please use a separate sheet for each offence. [Article 7(1) (k) & (l)]. ATTACHED Where the applicant is a sole trader or partnership, include details of any such conviction where any relevant person or partner was at any time within the last 10 years prior to this application, a director, manager, company secretary or similar officer for a body corporate. ATTACHED 10

14 Section B About the Applicant B.7 Technical Competence (Fit and Proper Person) Please detail the applicant(s) technical knowledge and qualifications relevant to the collection of waste. [Article 4 & Article 7(1) (k) & (l)] and [Article 17 (3) (c)]. Document(s) Reference: B.8 Financial Commitment Discharge [Article 4] To provide particulars in respect of such matters affecting the ability of the applicant(s) to meet the financial commitments or liabilities which will be entered into or incurred by the person(s) in carrying on the activity or in ceasing to carry on waste collection activity/s, please attach the following: The B.8 Declaration (Appendix 3) A copy of your current Tax Clearance/C2 Certificate issued by Irish Revenue ATTACHED NOTE: For applicants resident outside the Republic of Ireland, a Tax Clearance Certificate must be obtained from Irish Revenue. Failure to submit a Tax Clearance Certificate will result in an invalid application. B.9 Insurance Details Please complete the insurance declaration documents contained in Appendix 4 and Appendix 5. an indemnity of 6.5 million an indemnity to Offaly County Council (as Nominated Authority on behalf of all Local Authorities in the Republic of Ireland). ATTACHED Environmental Liability You are advised to investigate if Environmental Liabilities Insurance is appropriate for your proposed waste collection activity. While this is not a current requirement of the waste collection permit application process, it may be so in the future. 11

15 Section C About the Waste Collection Activity SECTION C - ABOUT THE WASTE COLLECTION ACTIVITY C.1 Waste Collection Areas and Regions Select the relevant box or boxes to identify the local authority area or areas in the regions where waste is or will be collected. REGION LOCAL AUTHORITY REGION LOCAL AUTHORITY ALL REGIONS All Local Authorities Clare County Council Galway City Council Galway County Council MID-WEST Kerry County Council Limerick City Council Leitrim County Council Limerick County Council CONNAUGHT Mayo County Council Cavan County Council Roscommon County Council NORTH-EAST Louth County Council Sligo County Council Meath County Council Monaghan County Council CORK Cork City Council Cork County Council Carlow Council Kilkenny County Council DONEGAL Donegal County Council Dublin City Council SOUTH-EAST South Tipperary County Council Waterford City Council DUBLIN Dun Laoghaire- Rathdown Council Fingal County Council Waterford County Council Wexford County Council South Dublin County WICKLOW Wicklow County Council KILDARE MIDLANDS Kildare County Council Laois County Council Longford County Council North Tipperary County Council Offaly County Council Westmeath County Council 12

16 Section C About the Waste Collection Activity C.2 General Waste Activity Please outline the general areas of your proposed waste activity by ticking the boxes below. You are advised to refer to the European Waste Catalogue (EWC code book). Batteries and Accumulators Bulky Waste Commercial and Industrial Waste Construction and Demolition Waste End of Life Vehicles Hazardous Waste Household Waste Incineration Waste Sludges/Slurries and Septic Tank Waste Waste Electrical and Electronic Equipment Waste Oils (Oil wastes and wastes of liquid fuels) Waste Tyres C.3 Waste Type and Description Please complete Table C.3 accompanying this application, this table can be completed by hand or electronically (electronic format is preferred). The table is available for download at Guidance on the use of the table is provided within the excel sheet itself. The electronic sheet provides two worksheets, one for household waste collections and the second for other waste collections. Both worksheets have drop down lists for applicants to select region, local authority areas and waste types corresponding to the European Waste Catalogue (EWC). The EWC catalogue can be downloaded from or Worksheet 1, i.e. the household waste collection sheet is presented in two parts. Part 1 deals with door to door waste collections and Part 2 deals with collection of other household wastes for example, septic tank sludge, garage clearances, bring centres. NOTE: Sample rows have been completed as examples of the information to be included in Table C.3 please delete these rows before completion. ATTACHED 13

17 Section C About the Waste Collection Activity C.4 Regional Waste Plan requirements or requirements of National Hazardous Waste Management Plan Have you consulted the relevant Regional Waste Plans and Hazardous Waste Management Plan relative to your proposed activity? Yes Local Authority Jurisdiction: No Select Relevant Jurisdiction C.5 Facilities in Ireland In addition to the details of any facility or facilities that is intended to be used in connection with the waste collection as requested in Table C.3, please attach the letter/s of acceptance from each facility that is intended to be used in connection with the waste collection activity. These letters must be provided on the facility/s headed paper, detailing their agreement to accept the specified waste types (EWC codes) and volumes, detail the facility authorisation reference and expiry date. Letters of acceptance must be signed by a facility manager or equivalent appointed person(s).please note letters of acceptance must be in date, i.e. dated within 6 months of the application being submitted. ATTACHED C.6 Facilities outside of Ireland Trans-Frontier Shipment (TFS) Amber Waste A copy of the numbered and completed TFS notification document (Annex 1A) (including EWC codes, haulier details and facility details including authorisation reference). A copy of the TFS list of carriers (Annexed to the TFS notification document, Annex 1A). A copy of the contract between the Exporter/ Person who arranges the shipment and Importer/Consignee facility. OR A letter of acceptance from the destination facility submitted by the permit holder. Where the application consists of the addition of a carrier to an existing TFS document, the request shall be accompanied by a letter from the Exporter/Notifier confirming that they will be making a request to the NTFSO to add the Waste Collection Permit holder as a carrier on their TFS. 14

18 Section C About the Waste Collection Activity Green Waste A copy of the completed Annex VII document. A copy of the list of carriers is required where the name of the relevant carrier is not entered in the Annex VII document. A copy of the contract between the Exporter/Person who arranges the shipment and Importer/Consignee facility. OR A letter of acceptance from the destination facility submitted by the permit holder. OR Contact details for the Broker/Dealer. Copy of NTFSO Registration Certificate for Broker/Dealer. ATTACHED C.7 Vehicles Do you currently have vehicles for waste collection? Yes No If yes, please provide the following details. (Continue on separate sheet if necessary). Registration Number Vehicle Type Owned/Leased or Owner Driver Vehicle Licensing Certificate Included 15

19 Section C About the Waste Collection Activity Registration Number Vehicle Type Owned/Leased or Owner Driver Vehicle Licensing Certificate Included A copy of the vehicle licensing certificate(s) in the name of the applicant. ATTACHED In the case of subcontractors / leased vehicles, further documentation is required, including a Motor Contingency Insurance Policy. Please contact the for details of this documentation. NOTE: For applicants who do not have vehicles at the application stage, if granted a waste collection permit, they must provide vehicle details to the prior to waste collection activities commencing. 16

20 Section C About the Waste Collection Activity C.8 Skips Please state skip type and volume for all skip containers (if applicable). (Insert more rows if necessary). Skip Type Volume (Cubic Metres) Number of these Skip Types Total Volume (Cubic Metres) Document(s) Reference: Is the applicant licensed under the control of Skip bye-laws? (Please refer to the Roads Division of the relevant Local Authority for these details). Yes No If yes, please give details as they appear on the Skip Operating Licence: Skip Operator Name and Licence Number Skip Operator Address C.9 Food Waste Do you intend to collect Food Waste from premises as set out in Schedule 1 of S.I. No. 508 of 2009 Waste Management (Food Waste) Regulations 2009 as part of your waste collection activity? Yes No If yes, please submit details of how the applicant(s) proposes to collect food waste from the premises of the producers listed in the specified classes of Schedule 1 of these Regulations and in compliance with S.I. No. 508 of 2009 Waste Management (Food Waste) Regulations. ATTACHED 17

21 Section D Additional Information SECTION D - ADDITIONAL INFORMATION D.1 Additional Information If there is additional information which the applicant feels may be required or beneficial to the in making its decision or any information identified during pre-application consultation, this should be included here. Supporting documents may be provided. Document(s) Reference: 18

22 APPENDICES

23 Appendix 1 (Version 2.2) Appendix 1 - Statutory Declaration Original, stamped document to be submitted. I declare that the information given in the application by (1) for the purpose of obtaining a waste collection permit is correct, and that no information which is required to be included in the said application has been omitted. I make this solemn declaration conscientiously believing the same to be true and by virtue of the Statutory Declarations Act I authorise OFFALY COUNTY COUNCIL as the NATIONAL WASTE COLLECTION PERMIT OFFICE to make any enquiries from official sources as it may consider necessary for the purpose of determining this application and, pursuant to Section 8 of the Data Protection Act 1988, I consent to the disclosure of details of convictions for relevant offences specified under Article 21 of the Waste Management (Collection Permit) Regulations *Signature: Name: (block capitals) **Declared before me at this day of, 20 Signature of Witness: Occupation: Date: WARNING ANY PERSON WHO GIVES FALSE OR MISLEADING INFORMATION FOR THE PURPOSE OF OBTAINING A WASTE COLLECTION PERMIT RENDERS THEMSELVES LIABLE TO SEVERE PENALTIES. (1) Insert legal entity. * To be signed by the applicant, each partner if in the case of a partnership, or a director, manager, company secretary or similar officer in the case of a body corporate. ** To be completed by a Solicitor/Commissioner of Oaths/Notary Public/Peace Commissioner/Garda Síochána. 19

24 Appendix 2 (Version 2.2) Appendix 2 - Suggested Newspaper Notice Format (Only in the case of new application for a single or multi-regional waste collection permit) (THE FOLLOWING PARAGRAPH TO BE PRINTED IN UPPERCASE) APPLICATION TO OFFALY COUNTY COUNCIL AS THE NATIONAL WASTE COLLECTION PERMIT OFFICE () FOR A WASTE COLLECTION PERMIT RELATING TO A WASTE COLLECTION ACTIVITY OR WASTE COLLECTION ACTIVITIES IN (A) (B) will be making an application to the, within ten working days from the date of this notice, for a waste collection permit to collect (C) waste in (D) A copy of the application will, as soon as is practicable after receipt by the be available for inspection and for purchase at the principal offices of the local authority area or areas listed above. (A) (B) (C) (D) Insert name of relevant region or regions - SEE NOTE 1 OPPOSITE. Insert applicant s full name and address of principal place of business. Fully describe the nature of waste collection activities - SEE NOTE 2 OPPOSITE. State name of local authority area or areas - SEE NOTE 3 OPPOSITE. 20

25 Appendix 2 (Version 2.2) THE FOLLOWING NEWSPAPERS CIRCULATE IN ALL 34 LOCAL AUTHORITY AREAS: The Irish Independent The Irish Times The Irish Sun The Irish Star Proof of circulation should be requested for all other newspapers Where some newspapers circulate in the majority of areas e.g. the Irish Examiner, or Evening Herald, then a combination of this paper plus a local paper will be acceptable. NOTE 1: The Regions are: North East, South-East, Cork, Mid-West, Connaught, Midlands, Wicklow, Kildare, Donegal, Dublin or All Regions. This can be worded for example as: The Midlands Region, or All Regions, or The Midlands, Cork and Dublin regions as appropriate NOTE 2: Examples are: Hazardous & non-hazardous, commercial, industrial, household, construction & demolition waste, sludges, slurries and septic tank waste. Note: Avoid narrow classifications e.g. concrete. In this case Construction & Demolition waste will give a wider scope to the applicant in their waste collection activity. NOTE 3: The Local Authority areas are: Meath, Cavan, Louth and Monaghan County Councils. Kilkenny, Carlow, South Tipperary, Wexford, Waterford County Councils and Waterford City Council. Cork County Council and Cork City Council. Limerick County Council, Limerick City Council and Clare and Kerry County Councils. Mayo, Leitrim, Roscommon, Sligo, Galway County Council and Galway City Council. Offaly, Laois, Longford, North Tipperary and Westmeath County Councils. Wicklow County Council. Kildare County Council. Donegal County Council. Dublin City Council and Dun Laoghaire-Rathdown, Fingal and South Dublin County Councils. Or, for Multi-regional applications including all Local Authority Areas; All City and County Council Areas. Note: All Local Authority areas where the applicant proposes to collect waste must be included in the newspaper notice to be deemed as a valid notice. Applicants are advised to seek advice in relation to their newspaper notice from the by availing of a pre-application consultation. A newspaper notice will not be pre-approved and will only be validated by the office following the submission of a complete application. You are also advised to use the newspaper notice checklist in Appendix 7. 21

26 Appendix 3 (Version 2.2) Appendix 3 - Question B.8 Financial Commitment Discharge Declaration Original, stamped document to be submitted. This document must be completed to satisfy the that the applicant meets the full definition of a fit and proper person as defined in Article 4 of the Waste Management (Collection Permit) Regulations, 2007 as amended. Please note that under Article 17(3) the shall not grant a waste collection permit unless it is satisfied that the applicant is a fit and proper person. All applicants are required to make signed declaration stating their financial ability to properly carry out waste handling and waste collection in a manner that will not cause environmental pollution or breach environmental standards. The following declaration is to be completed by a financial representative of the applicant, e.g. company accountant or bank manager, or finance director/manager etc. SIGNED FINANCIAL DECLARATION It is my opinion that the applicant is likely to be in a position to meet any financial commitments or liabilities that will be entered into or incurred by the applicant in carrying out the waste collection activity to which the waste collection permit relates in accordance with the terms of the permit or in consequence of ceasing to carry on that activity. Signature: Name (Block Capitals): OFFICIAL STAMP Position or Title: Financial Institution (if applicable): Date: WARNING: IT IS AN OFFENCE UNDER ARTICLE 36 (1) OF THE WASTE MANAGEMENT (COLLECTION PERMIT) REGULATIONS 2007, AS AMENDED, FOR ANY PERSON TO PROVIDE FALSE OR MISLEADING INFORMATION FOR THE PURPOSES OF OBTAINING A WASTE COLLECTION PERMIT. 22

27 Appendix 4 (Version 2.2) Appendix 4 - Question B.9 Motor Vehicle Insurance Declaration for Waste Collection Original, stamped document to be submitted. (To be completed by the applicant s insurance company/insurance broker) This document must be completed to satisfy the that the applicant meets the full definition of a fit and proper person as interpreted in Article 4 of the Waste Management (Collection Permit) Regulations, 2007 as amended. Please note that under Article 17(3)(c) a nominated authority shall not grant a waste collection permit unless it is satisfied that the applicant is a fit and proper person. SIGNED DECLARATION I confirm that the applicant (Name) has a Motor Vehicle Insurance Policy covering the use of all vehicle(s) registration(s) (if fleet policy state fleet policy ) in relation to his/her/it s activities identified in Table 1 below, which are the subject matter of the Waste Collection Permit, including: A Third Party Property Damage Limit of 6.5m. Yes No An indemnity to Offaly County Council (as Nominated Authority on behalf of all Local Authorities in the Republic of Ireland). Yes No Policy No.: Expiry Date of Policy: Insurer: TABLE 1 Batteries and Accumulators Household Waste Bulky Waste Incineration Waste Commercial and Industrial Waste Sludges/Slurries and Septic Tank Waste Construction and Demolition Waste Waste Electrical and Electronic Equipment End of Life Vehicles Waste Oils (Oil wastes and wastes of liquid fuels) Hazardous Waste Waste Tyres 23

28 Appendix 4 (Version 2.2) Signature:... Name (Block Capitals):... OFFICIAL STAMP Position or Title:... Insurance Broker or Company:... Date:... ADDITIONAL COMMENTS: WARNING: IT IS AN OFFENCE UNDER ARTICLE 36 (1) OF THE WASTE MANAGEMENT (COLLECTION PERMIT) REGULATIONS 2007, AS AMENDED, FOR ANY PERSON TO PROVIDE FALSE OR MISLEADING INFORMATION FOR THE PURPOSES OF OBTAINING A WASTE COLLECTION PERMIT. 24

29 Appendix 5 (Version 2.2) Appendix 5 - Question B.9 Public Liability Insurance Declaration for Waste Collection Original, stamped document to be submitted. (To be completed by the applicant s insurance company/insurance broker) This document must be completed to satisfy the that the applicant meets the full definition of a fit and proper person as interpreted in Article 4 of the Waste Management (Collection Permit) Regulations, 2007 as amended. Please note that under Article 17(3) (c) a nominated authority shall not grant a waste collection permit unless it is satisfied that the applicant is a fit and proper person. SIGNED DECLARATION I confirm that the applicant (Name) has a Public Liability Insurance Policy covering his/her/it s activities, identified in Table 1 below, which are the subject matter of the Waste Collection Permit, including: Limit of indemnity of at least 6.5m any one occurrence, including sudden/unforeseen pollution risks. An indemnity to Offaly County Council (as Nominated Authority on behalf of all Local Authorities in the Republic of Ireland). Does Policy include Irish Law Jurisdiction? (only relevant in insured is based outside ROI) Yes Yes Yes No No No Policy No.: Expiry Date of Policy: Insurer: TABLE 1 Batteries and Accumulators Household Waste Bulky Waste Incineration Waste Commercial and Industrial Waste Sludges/Slurries and Septic Tank Waste Construction and Demolition Waste Waste Electrical and Electronic Equipment End of Life Vehicles Waste Oils (Oil wastes and wastes of liquid fuels) Hazardous Waste Waste Tyres 25

30 Appendix 5 (Version 2.2) Signature:... Name (Block Capitals):... OFFICIAL STAMP Position or Title:... Insurance Broker or Company:... Date:... ADDITIONAL COMMENTS: WARNING: IT IS AN OFFENCE UNDER ARTICLE 36 (1) OF THE WASTE MANAGEMENT (COLLECTION PERMIT) REGULATIONS 2007, AS AMENDED, FOR ANY PERSON TO PROVIDE FALSE OR MISLEADING INFORMATION FOR THE PURPOSES OF OBTAINING A WASTE COLLECTION PERMIT. 26

31 Appendix 6 (Version 2.2) Appendix 6 Question 2.2 Declaration for Revocation of Single Region Waste Collection Permits Original, stamped document to be submitted. I/We agree that the following Waste Collection Permit(s) outlined in the Table below, in the name(s) of will be revoked by the National Waste Collection Permit Office () as a consequence of the successful granting of this Single Region/ Multi Regional Waste Collection Permit. This Declaration discharges the duty of the to review the Waste Collection Permit(s) listed below prior to revoke in accordance with Section 34 (6) of Waste Management Act 1996 as amended. Waste Collection Permit Number Nominated Authority Signature: Name (Block Capitals): OFFICIAL STAMP Position or Title: Date: WARNING: IT IS AN OFFENCE UNDER ARTICLE 36 (1) OF THE WASTE MANAGEMENT (COLLECTION PERMIT) REGULATIONS 2007, AS AMENDED, FOR ANY PERSON TO PROVIDE FALSE OR MISLEADING INFORMATION FOR THE PURPOSES OF OBTAINING A WASTE COLLECTION PERMIT. 27

32 Appendix 7 (Version 2.2) Appendix 7 - Checklist of Information To be supplied with application. INFORMATION REQUIRED: ARTICLE INCLUDED One fully completed application form ONLY. Completed worksheet for Question C.3. One electronic copy on CD. For new applications: A copy of the relevant page from the newspaper(s) in which notice(s) in accordance with Article 6 have been published. (Template in Appendix 2) An original Statutory Declaration form (Appendix 1). A copy of current Tax Clearance/C2 Certificate from Irish Revenue. 6 & 7(3)(a) 7(3)(b) 7(3)(c) An original Financial Declaration form (Appendix 3). An original Motor Insurance Declaration form (Appendix 4). An original Public Liability Insurance Declaration form (Appendix 5). Letters of acceptance from each facility that is intended to be used in connection with the waste collection activity. A copy of the vehicle registration certificate for each vehicle. The appropriate fee (*see note overleaf). 7(3)(f) IF APPLICABLE PROVIDE THE FOLLOWING: ARTICLE INCLUDED Details of any court hearing, case, nature of the offence and any penalty or requirements imposed by the court. Where the applicant is a person or partnership, include details of any such conviction where the person or partner was at any time within the last 10 years prior to this application, a director, manager, company secretary or similar officer for a body corporate 7(1)(k)&(i) & 21 7(1)(l), 21 A copy of Notice from nominated authority instigating a review. 23(3) Any form of correspondence that may have been received from nominated authority regarding consultation, or contact name and number, if available. A copy of the applicant s Certificate of Incorporation issued by the Companies Registration Office. 23(3)(a)(iv) 7(3)(d) 28

33 Appendix 7 (Version 2.2) IF APPLICABLE PROVIDE THE FOLLOWING: (Continued...) ARTICLE INCLUDED A copy of the printout from the Companies Registration Office detailing the Company Directors A copy of proof of trade name. 7(3)(e) Copy of the relevant documentation for the export of waste to each facility outside of Republic of Ireland. A copy of the documentation specified by the for the leasing of vehicles or the sub-contracting of waste collection C.7. Details of proposals for compliance with the Food Waste Regulations C.9. An original Declaration for Revocation of Single Region Waste Collection Permits (Appendix 6). APPLICATION FEES *NOTE New Application Fees In the case of a single-region Permit the fee payable is 1,000 In the case of a multi-region Permit the fee payable is 1,000 per region up to a maximum charge of 5,000 for all Regions. Review Fees In the case of a single-region Permit the review fee payable is 500 In the case of a multi-region Permit the review fee payable is 500 per region up to a maximum charge of 2,500 for all Regions. NEWSPAPER CHECKLIST APPLICATION TO OFFALY COUNTY COUNCIL AS NATIONAL WASTE COLLECTION PERMIT OFFICE (), FOR A WASTE COLLECTION PERMIT RELATING TO A WASTE COLLECTION ACTIVITY OR WASTE COLLECTION ACTIVITIES IN (<<NAME REGION OR REGIONS>>) Full name and address of principal place of business of the applicant. State that the application for a WCP will be made to the within 10 working days of the newspaper notice. Specify the nature of the waste collection activity to which the application relates and the local authority area or areas in which the collection activity or activities will be carried on. State that a copy of the application will be available for inspection or purchase at the principal offices of the Local Authorities from as soon as may be., Offaly County Council, Áras an Chontae, Charleville Rd, Tullamore, Co. Offaly. Ph: Fax: Web:

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