Expression of Interest Form– Thermoplastic Road Surface Art Works Designs & Sculptural Works Please refer to the EoI documentation when completing the form. Return to: Linda Lacey Coordinator Place & Cultural Development llacey@charlessturt.sa.gov.au Ph 08 8408 1368 Expression of Interest must be received by 5pm Friday 14 December DETAILS NAME: TRADING NAME: (if applicable) ABN: GST REGISTRATION STATUS (yes or no) CONTACT DETAILS STREET ADDRESS: CITY: STATE: POSTCODE: TELEPHONE/MOBILE: EMAIL: Postal Address (if different from above) INSURANCE DETAILS: PUBLIC LIABILITY INSURER: POLICY #: COVERAGE AMOUNT: EXPIRY: NAME ON POLICY: Expression of Interest Artwork preference: (please tick, can select multiple) Thermoplastic artwork designs □ Four Two Sculptures □ If chosen to develop a design, please describe the creative direction you would like to explore: (eg. Artistic approach/ inspiration/ themes / colours/ vision)
Expression of Interest Form– Thermoplastic Road Surface Art Works Designs & Sculptural Works Please refer to the EoI documentation when completing the form. Return to: Linda Lacey Coordinator Place & Cultural Development llacey@charlessturt.sa.gov.au Ph 08 8408 1368 Expression of Interest must be received by 5pm Friday 14 December DETAILS NAME: TRADING NAME: (if applicable) ABN: GST REGISTRATION STATUS (yes or no) CONTACT DETAILS STREET ADDRESS: CITY: STATE: POSTCODE: TELEPHONE/MOBILE: EMAIL: Postal Address (if different from above) INSURANCE DETAILS: PUBLIC LIABILITY INSURER: POLICY #: COVERAGE AMOUNT: EXPIRY: NAME ON POLICY: Expression of Interest Artwork preference: (please tick, can select multiple) □ Four Thermoplastic artwork designs □ Two Sculptures If chosen to develop a design, please describe the creative direction you would like to explore: (eg. Artistic approach/ inspiration/ themes / colours/ vision)
Expression%20of%20Interest%20Form%20-%20Thermoplastic%20Road%20Surface%20Aft%20Works%20Designs%20&%20Sculptural%20Works.docx