PUBLIC BUILDING WIFI APPLICATION FORM
The Super Connected Cardiff Project aims to improve Internet across the city through a number of projects including Public WiFi. The Public Building WiFi Project aims to address digital inclusion and improve visitor experience by making free WiFi available in public buildings across Cardiff.
The Public Building WiFi Scheme is available to Registered Charities, Charitable Companies, Social/Community Enterprises, Community Interest Companies amongst others. The project will deliver free WiFi solution for the duration of 5 years to the Public Areas of eligible public buildings.
The scheme is only applicable for the public areas where there is no charge for entry. Back offices and retail space are not in scope of this project.
Applications will be assessed by a panel which will evaluate the applications based on eligibility, business case and state aid levels. On approval of an application the Super Connected Cardiff Team will arrange for the supplier to install the WiFi.
Applicants will be able to apply for more than one building per organisation but this will be dependant on state aid de minimis levels.
Please refer to Public Building WiFi Guidance document for further information.
Completed applications should be submitted by 30 November 2014.
Please tick the box which describes the category of your application
Social/Community Enterprise Community Interest Company
Registered Charity Industrial/provident society
Charitable company Other (please state)……….
SECTION 1 – YOUR ORGANISATION DETAILS
1.1 Applicant’s Contact Details (this should be the person responsible for making the application)
Name:...
Email address:………...
Telephone Number:...
Your position within the organisation (The person applying must be able to accept any offer made on behalf of the organisation)
………...
1.2 Organisation Details
Name of Organisation:...
Address including postcode This will be the WiFi installation address (Your postcode will be used to check you are in an eligible area):
...
……..………..………..
Organisation Web Site (if available):...
Organisation Email address:………...
Telephone Number:...
What are your organisation’s main activities?
...
...
……….
Does the Organisation have ownership of the premises? Yes No
If “No”, please enclose a letter or an email from your landlord consenting to the works to be undertaken
Landlord Name:………..……….
Landlord Email:……….………
Landlord Contact Telephone:……….
When does your current lease expire? (please insert date) ………..……..………
Registration Number – please complete the number that applies to your organisation:
Organisation Registration Number (if applicable) Unique Tax Reference (Sole Trader)
Charity Registration Number Business Rates Ref (if applicable )
Is your business VAT Registered? Yes No
VAT Registration Number
(if applicable): ...
SECTION 2 – BUILDING DETAILS
Please specify what time the building is open to the public:
...
Is the admission to the building free of charge? Yes No Are there any structural hazards in the
building? (for example Asbestos – you will be asked to provide details on approval of this application)
Yes No
Please list any hazards
……….
……….………
What are the public areas in your building (for example reception, meeting areas)? Please enclose plans of your building with the public areas highlighted with your application
...
...
Please provide footfall figures of the building (if available)
...
SECTION 3 – BENEFITS OF THE NEW WIFI SOLUTION
Are there any members of staff on hand who will be providing help/assistance to the public to use WiFi? Please provide a summary of how the assistance will be provided.
………...
……….
Are there any WiFi devices (laptops, tablets, iPads) available to the public in the building?
...
Please tell us how new WiFi solution will benefit members of public? (Please tick all the boxes that apply to you. This information will be used to enable us to measure the benefits of this scheme).
Improved Customer Service
Improved IT skills and recruitment opportunities Easy access to tourist information for visitors Improved visitor experience
Access to support or government websites Helps address Digital Inclusion
Are there any other benefits you expect to see as a result of taking on WiFi service?
……….………
……….………
SECTION 4 – DATA PROTECTION & DECLARATION
4.1 - Data Protection
The information which you provide on this form will be used by City of Cardiff Council to assess your application for Public Building WiFi. We will use the information provided for administration and management purposes, including carrying out appropriate credit checks and site surveys. In addition we will need to share this information with associated organisations in the management of this project.
You have the right to ask for a copy of the information we hold on you that is subject to the Data Protection Act 1998 and to correct any inaccuracies in your information. There may be a small administrative charge for this service.
Please tick this box if you would like to be contacted either by email, telephone or mail with details of future services which may be relevant to you.
Email Telephone Mail
4.2 – Declaration
All Applicants are required to read this declaration, and to sign and date the form:
I the undersigned apply for inclusion in the free public building WiFi project and I agree to the following terms:
§ I consent to the City of Cardiff Council to undertake any credit checks considered necessary to assess the application.
§ I consent to the City of Cardiff Council to use the project as a case study for publicity purposes.
§ I understand that the Free WiFi Service will be provided for 5 years following installation.
After which time I accept that I will be responsible for all ongoing costs.
§ I understand that the Council may request further information to support the business case from the applicant as part of the approval process.
§ I declare that the information on this form, and any other information given in support of the application, is correct to the best of my knowledge.
§ I understand that the Council has the right to withdraw offer of application if cost significantly increase due any unforeseen building hazards (i.e. asbestos).
§ I understand providing wrong or deliberately misleading information is an offence and that such information may be used against me in any subsequent criminal investigation.
§ I understand that if I have provided incorrect or misleading information as part of this Application or in support of this Application including where applicable, but not limited to, any information relating to the amount of ‘de minimis aid’ I have received then I will be required to repay all of the Funding to City of Cardiff Council immediately.
§ I understand that the information provided on this form may be made available to other Departments/Agencies for the purpose of preventing or detecting crime.
§ I understand that City of Cardiff Council and DCMS retain the right to audit any of the works carried out as a direct result of this support scheme.
§ I understand that I must inform City of Cardiff Council immediately of any change in circumstances which may affect this application in relation to this scheme.
§ I understand that if I have provided incorrect or misleading information as part of this Application or in support of this Application including where applicable, but not limited to, any information relating to the amount of ‘de minimis aid’ I have received then I will be required to repay all of the Funding to City of Cardiff Council immediately.
§ I have read and understood the Guidance notes, in relation to public funding, freedom of information and Data protection.
§ I acknowledge that if I fail to meet the De Minimis Eligibility Criteria, I/we shall become liable to pay the full price that would otherwise be payable in respect of the services received.
§ I declare that we have not already received aid exceeding the de minimis ceilings over the last 3 financial years as set out under Section 4.2 of this Application Form.
§ I declare that we are not in difficulty as defined by Council Regulation 2004/C 244/02.
I now confirm that:
§ I have read and understood the full terms and conditions in the guidance for applicants
§ I confirm that my organisation is eligible to receive funding under State Aid de minimis rules
§ I confirm that my organisation is eligible to receive funding
§ I understand that I will need to abide by the terms and conditions
§ I confirm that I agree for the Councils Business rates to be checked in line with the review of this application
I enclose the following documents to support my application:
§ A letter or an email from landlord consenting to the installation works
§ A copy of the building plans with required Public WiFi coverage
§ A copy of the most recent financial accounts for my organisation
§ A copy of my organisation’s Constitution.
Neither City of Cardiff Council nor its staff can be liable for loss resulting from action taken on the basis of general information provided. This application form does not constitute any form of contract.
The completion and submission of this form by Applicants does not guarantee an offer of funding from City of Cardiff Council. City of Cardiff Council retains discretion in relation to the assessment of all applications. City of Cardiff Council reserves the right to alter any element of the project, including the eligibility criteria, at any time without further notice.
City of Cardiff Council reserves the right to discontinue the project at any time without further notice.
Signed:……….………..
Full Name (please print):………
Title:………..………..………
Date:……….………
Before you send in your application please ensure that you have completed all sections of this form and you have included with your application form:
· Landlord Consent
· A copy of the building plans with required Public WiFi coverage
· A copy of your organisation’s financial accounts
· A copy of your organisation’s constitution
Please note that this information is mandatory and failure to provide it will result in a delay your application.
The closing date for application is the 30th of November 2014.
Once completed please send to [email protected]
Or:
Super Connected Cardiff City of Cardiff Council County Hall
Cardiff CF10 4UW
If you have any problems completing this form please contact the Digital Cardiff Team on the above email.
