ࡱ> { $bjbj|| ;0ff\$$2222222282<3D2=SR3h3h3h3h3444RRRRRRRVyYR274477R22h3h34Rk8k8k87F2h32h3Rk87Rk8k8NNQh3`c7FVP0R S0=SP!Z7d!Z`QQV!Z2Q4v5Tk8f5D5s444RR 8^444=S7777!Z444444444$X L1: State Fleet Safety Policy Exemption Request Agency name - [Insert Agency Name] Current vehicle(s) [where applicable] Registration number(s) - Insert Registration Number(s) Make and Model - Insert Current Vehicle Make & Model(s) Additional/Replacement Vehicle(s) Make and Model - Insert New Vehicle Make & Model(s) All requests for an exemption are considered on a case-by-case basis, and the requesting Agency must be able to demonstrate that a business need cannot be adequately met by a vehicle on the contract list. The Agency formally acknowledges that this new vehicle request does not meet the 5-star Australasian New Car Assessment Program (ANCAP) safety rating stipulated in the current WA Fleet Policy and Guidelines (the Policy). Vehicles rated with fewer than 5 stars represent a greater risk of death or injury in the event of a crash. For all new vehicles the Policy states that: All passenger vehicles must be ANCAP 5-star rated; and All light commercial vehicles, including sports utility vehicles, must be ANCAP 5-star rated, where available and fit for purpose. The Agency requests exemption from the safety policy for this new vehicle(s) and formally acknowledges the following: This vehicle type is required based on operational needs and no other (safer) vehicle on the contract list is suitable; and A risk assessment has been undertaken. EXEMPTION REQUESTED BY Contact PersonInsert NamePosition TitleInsert TitleDivision/BranchInsert Div/BranchContact No.Insert NoPlease provide justification for the exemption request and supporting documentation, if necessary. The scope of the exemption should be limited to a vehicle, group of vehicles, period or until a suitable alternative becomes available. EXEMPTION REQUEST SUPPORTED BY CHIEF EXECUTIVE OFFICER (ACCOUNTABLE OFFICER) NameInsert NameTitleInsert TitleSignatureDateSignature Date Please send this completed form to State Fleet via email  HYPERLINK "mailto:statefleet@finance.wa.gov.au" statefleet@finance.wa.gov.au. For further information or assistance, please contact Max Cummock on 08 6551 1449      16 Parkland Rd Osborne Park Western Australia 6017 Locked Bag 11, Cloisters Square Western Australia 6850 Telephone: (08) 6551 1555 Facsimile (08) 6551 2333 www.finance.wa.gov.au   -=>PQRagyzҿteQC6(h_B*CJ^JaJphhzJZh_CJ^JaJh_CJOJQJ^JaJ&h_h_6CJOJQJ\^JaJh_CJOJQJ\^JaJ h_5CJOJQJ\^JaJhW6B*CJaJph h_h_6B*CJaJphhWB*CJaJphhzJZh_B*CJaJph$hJhh_5B*CJ^JaJphs)h5th_B*CJ(OJQJ^JaJ(phs/h5th_5B*CJ(OJQJ\^JaJ(phs -Rz F  m W X l$da$gd_i$ & F;^`;a$gd_ i & F>gd_ ldgd_ j$da$gd_ jdgd_kgd_igd_ j$a$gd_j$a$gd_   " E F    > S e k l ıߜ|kk]OAhB*CJ^JaJphh?5B*CJ^JaJphh~|B*CJ^JaJph!hRcWh_B*CJ^JaJphh_h_6CJ^JaJ#h_B*CJOJQJ^JaJph)h_5B*CJOJQJ\^JaJph$h_h_6B*CJ^JaJphh_B*CJ^JaJphhzJZh_CJ^JaJh_B*CJ^JaJph$h_h_6B*CJ^JaJph l m $ % W X \ c   J K q r ҼҗҗҏskV)h_5B*CJOJQJ\^JaJphh?5CJaJh?5CJOJQJ^JaJh_CJOJQJ^JaJhCJaJ#h_B*CJOJQJ^JaJphh_h_CJaJh~|CJaJh_CJaJhB*CJ^JaJphh_B*CJ^JaJph!h8]h_B*CJ^JaJphh?5B*CJ^JaJph J q r l$$Ifgd_ i$$Ifgd_l$gd_igd_i & Fgd_i & F;^`;gd_ ]ʮ~~iiWEWi8h_h_CJ^JaJ"h~|CJOJQJ^JaJnH tH "hWCJOJQJ^JaJnH tH (h_h_CJOJQJ^JaJnH tH 'h_h_5B*CJ\^JaJph7h_h_5B*CJOJQJ\^JaJnH phtH 7h_h_6B*CJOJQJ\^JaJnH phtH h; h_nH tH .h_h_5CJOJQJ\^JaJnH tH #h_B*CJOJQJ^JaJph 8+++ l$$Ifgd_kd$$Ifl\ C$v (I  t0644 lapyt_ +kd$$Ifl\ C$v (I  t0644 lapyt_ l$$Ifgd_ 6;GMZvj____ i$$Ifgd_ l$]gd_ l$a$gd_jkd$$Ifl=$$ t0644 layt?5i$"u}$If]"^ugd_56;GMZ[efklm|}oaM*B*CJOJQJU\^JaJph,h_5>*B*CJOJQJ\^JaJph5jh_5>*B*CJOJQJU\^JaJph)h_5B*CJOJQJ\^JaJphhijkl  !"#$ h'/hshRph'cOhg(B*CJaJphNj]hg(B*CJaJphNj]hg(jh~|U 9 01h/R :p. 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