subarachnoid hemorrhage guidelines 2019

28/02/2021

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(Revised recommendation from previous guidelines), Prophylactic hypervolemia or balloon angioplasty before the development of angiographic spasm is not recommended (Class III; Level of Evidence B). The weight of evidence or opinion is in favor of the procedure or treatment. Connolly ES Jr ,et al. Neither aminocaproic acid nor tranexamic acid is approved by the US Food and Drug Administration for prevention of aneurysm rebleeding. In the most … For patients with ruptured aneurysms judged to be technically amenable to both endovascular coiling and neurosurgical clipping, endovascular coiling should be considered. 6. When the blood is located in the sulci, CTA should be scrutinized for vasculitis, and DSA is recommended for confirmation.109 Others have shown that CTA may not reveal small aneurysms and that 2- and 3-dimensional cerebral angiography should be performed, especially when the hemorrhage is accompanied by loss of consciousness.110 In cases of diffuse aSAH pattern, most agree that negative CTA should be followed by 2- and 3-dimensional cerebral angiography. 11. Contact Us, A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association, and on behalf of the American Heart Association Stroke Council, Council on Cardiovascular Radiology and Intervention, Council on Cardiovascular Nursing, Council on Cardiovascular Surgery and Anesthesia, and Council on Clinical Cardiology. Acute diagnostic workup should include noncontrast head CT, which, if nondiagnostic, should be followed by lumbar puncture (Class I; Level of Evidence B). Anemia is common after aSAH and may compromise brain oxygen delivery.326 Transfusion of red blood cells in anemic patients with aSAH results in a significant rise in cerebral oxygen delivery and a reduction in oxygen extraction ratio.327 Data obtained from prospective registries of patients with aSAH suggest that higher hemoglobin values are associated with improved outcomes after aSAH.328,329 Nevertheless, thresholds for blood transfusion have been dictated in a nonsystematic manner and have therefore varied widely. Aggressive control of fever to a target of normothermia by use of standard or advanced temperature modulating systems is reasonable in the acute phase of aSAH. Many significant advances in the understanding of aSAH-induced vasospasm and DCI have been made since publication of the previous version of these guidelines, which focused on prevention with oral nimodipine and maintenance of euvolemia, as well as treatment with triple-H therapy (hemodynamic augmentation therapy) and/or endovascular therapy with vasodilators and angioplasty balloons. 1. Between the time of aSAH symptom onset and aneurysm obliteration, blood pressure should be controlled with a titratable agent to balance the risk of stroke, hypertension-related rebleeding, and maintenance of cerebral perfusion pressure. The use of fludrocortisone acetate and hypertonic saline solution is reasonable for preventing and correcting hyponatremia (Class IIa; Level of Evidence B). Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Definition of Classes and Levels of Evidence Used in AHA Stroke Council Recommendations. The use of packed red blood cell transfusion to treat anemia might be reasonable in patients with aSAH who are at risk of cerebral ischemia. Predicting the growth of an individual intracranial aneurysm and its potential for rupture in a given patient remains problematic. In 1 large single-institution study in which anticonvulsants were used routinely, adverse drug effects were seen in 23% of patients.276 Another single-center retrospective study found that the use of prophylactic phenytoin was independently associated with a worse cognitive outcome at 3 months after aSAH.291 Data pooled from trials of the impact of other therapies also suggest a worse outcome in those treated with anticonvulsants, but use of anticonvulsants was also associated with vasospasm, DCI, and fever, which suggests that there may have been bias in who was treated with antiepileptic drugs.292 Although retrospective studies have not demonstrated a benefit for use of prophylactic anticonvulsants after aSAH,273,288 the studies were small and hampered by limitations (eg, anticonvulsant levels were not routinely monitored).2,273,288. Heparin-induced thrombocytopenia and deep venous thrombosis are relatively frequent complications after aSAH. Perfusion imaging with CT or magnetic resonance can be useful to identify regions of potential brain ischemia. Although randomized trials are unavailable, there may be a very clear clinical consensus that a particular test or therapy is useful or effective. Treatment of high blood pressure with antihypertensive medication is recommended to prevent ischemic stroke, intracerebral hemorrhage, and cardiac, renal, and other end-organ injury (Class I; Level of Evidence A). The only multicenter randomized trial comparing microsurgical and endovascular repair, ISAT, randomized 2143 of 9559 screened patients with aSAH across 42 neurosurgical centers.140 For a patient to be considered eligible for the trial, neurosurgeons and interventionalists had to agree that the aneurysm was comparably suitable for treatment with either modality. The resulting draft was sent to the entire writing group for comment. A nonrandomized study not included in the meta-analysis compared 95 patients who underwent aneurysm clipping, cisternal blood evacuation, and lamina terminalis fenestration with 28 comparable, non–blood-cleansed, endovascular therapy–treated patients and found that shunt-dependent hydrocephalus occurred in 17% of surgical patients versus 33% of patients treated with endovascular therapy (statistical significance not reported).237, aSAH-associated acute symptomatic hydrocephalus should be managed by cerebrospinal fluid diversion (EVD or lumbar drainage, depending on the clinical scenario) (Class I; Level of Evidence B). Temporary clipping is frequently used to improve surgical conditions and prevent intraoperative rupture during the surgical dissection of aneurysms. 20. Endovascular procedures differ from open procedures in that anticoagulation with heparin is frequently administered during the embolization of aneurysms. 7. Despite the classic presentation of aSAH, individual findings occur inconsistently, and because the type of headache from aSAH is sufficiently variable, misdiagnosis or delayed diagnosis is common. Stroke. Local Info The objective of this study was to investigate the independent risk factors affecting clinical outcomes in intracranial aneurysm patients with poor-grade aneurysm subarachnoid hemorrhage (aSAH) underwent different intervention … (New recommendation), Magnetic resonance imaging (fluid-attenuated inversion recovery, proton density, diffusion-weighted imaging, and gradient echo sequences) may be reasonable for the diagnosis of aSAH in patients with a nondiagnostic CT scan, although a negative result does not obviate the need for cerebrospinal fluid analysis (Class IIb; Level of Evidence C). 6. Determination of aneurysm treatment, as judged by both experienced cerebrovascular surgeons and endovascular specialists, should be a multidisciplinary decision based on characteristics of the patient and the aneurysm. Various diagnostic tools are commonly used to identify (1) arterial narrowing and/or (2) perfusion abnormalities or reduced brain oxygenation. Although CTA is sometimes considered sufficient on its own when an aneurysm will be treated with surgical clipping,114 substantial controversy remains about the ability of CTA to determine whether or not an aneurysm is amenable to endovascular therapy.115–120 In 1 series,115 95.7% of patients with aSAH were referred for treatment on the basis of CTA. Such use led to a decreased incidence in rebleeding without increasing the risk of DCI, but 3-month clinical outcomes were not affected.138 There was an increased risk of deep venous thrombosis but not pulmonary embolism. Some studies have reported no impact on outcome,276,278 whereas others found seizures to be independently associated with worse outcome.275 Two recent large, retrospective, single-institution studies of patients with aSAH found that nonconvulsive status epilepticus is a very strong predictor of a poor outcome.285,286 Although high-quality evidence for routine anticonvulsant use in aSAH is lacking, short-term prophylactic antiepileptic therapy is still commonly used in patients with aSAH,274,276,278 based on the argument that seizures in acutely ill patients with aSAH could lead to additional injury or rebleeding from an unsecured aneurysm. First, the case for nimodipine is even stronger, with a recent comprehensive meta-analysis confirming improved neurological outcomes by preventing processes other than large-vessel narrowing.209,210 Although there have been sparse new important data on the lack of benefit for prophylactic hypervolemia compared with maintenance of euvolemia, new data show that both prophylactic angioplasty of the basal cerebral arteries and antiplatelet prophylaxis are ineffective in reducing morbidity.211–213 Similarly, the only supportive data for the use of lumbar drainage come from a single case-control study,214 although there is ongoing investigation on the value of this intervention to reduce arterial spasm and DCI.214, The data are a bit better for intrathecal thrombolytic infusions, with a recent meta-analysis of 5 randomized, controlled trials suggesting a benefit despite some methodological weaknesses.215,216 There are also emerging data for several novel methods to reduce the incidence and ischemic consequences of aSAH-induced vasospasm. Stroke. A variety of titratable medications are available. The rationale for comprehensive stroke centers is based on the success of similar models for trauma. Prevention of intraoperative hyperglycemia during aneurysm surgery is probably indicated (Class IIa; Level of Evidence B). aSAH indicates aneurysmal subarachnoid hemorrhage; CTA, computed tomography angiography; DSA, digital subtraction angiography; CT, computed tomography; DSA, digital subtraction angiography; EVD, external ventricular drainage; DCI, delayed cerebral ischemia; and WFNS, World Federation of Neurological Surgeons. Endorsed by the American Association of Neurological Surgeons and Congress of Neurological Surgeons; and by the Society of NeuroInterventional Surgery. Definition of Classes and Levels of Evidence Used in AHA Stroke Council Recommendations. In an epidemiological study of Finnish smokers who were monitored for >13 years, increased consumption of yogurt (but not all dairy products) was associated with a higher risk of aSAH.41 Greater vegetable consumption is associated with a lower risk of stroke and aSAH.42 Higher coffee and tea consumption43 and higher magnesium consumption44 were associated with reduced risk of stroke overall but did not change the risk of aSAH. (It should be noted that this agent has been shown to improve neurological outcomes but not cerebral vasospasm. In some patients, increased mean arterial pressures may increase cerebral blood flow in the setting of autoregulatory dysfunction. Therefore, urgent evaluation and treatment of patients with suspected aSAH is recommended. One of the main goals of the anesthetic technique is keeping the patient motionless to optimize the quality of the images used to perform the endovascular procedure; hence, general anesthesia with endotracheal intubation is often preferred for these procedures. Surgical clipping or endovascular coiling of the ruptured aneurysm should be performed as early as feasible in the majority of patients to reduce the rate of rebleeding after aSAH (Class I; Level of Evidence B). Systemic hypothermia has been used in several clinical settings, including head injury, ischemic stroke, and circulatory arrest, to protect the brain against ischemic injury.182–188 Use of hypothermia during craniotomy for the treatment of ruptured cerebral aneurysm was evaluated in a multicenter randomized, controlled trial. Clazosentan, an endothelin-1 receptor antagonist, had been shown to be associated with a dose-dependent reduction in the incidence of angiographic vasospasm in a phase IIb trial (Clazosentan to Overcome Neurological iSChemia and Infarct OccUrring after Subarachnoid hemorrhage [CONSCIOUS-1]).220 A benefit for clinical outcomes was not initially apparent but then was judged present when a stricter definition of vasospasm-related stroke was used. Although there is some suggestion of reduction in delayed ischemic deficits associated with magnesium infusion, a benefit has not been conclusively shown in a meta-analysis.222 A phase 3 trial (Intravenous Magnesium sulfate for Aneurysmal Subarachnoid Hemorrhage [IMASH]) did not support any clinical benefit from magnesium infusion over placebo in aSAH.223 A larger randomized trial is under way. DSA with 3-dimensional rotational angiography is indicated for detection of aneurysm in patients with aSAH (except when the aneurysm was previously diagnosed by a noninvasive angiogram) and for planning treatment (to determine whether an aneurysm is amenable to coiling or to expedite microsurgery). 8. However, a subsequent trial (CONSCIOUS-2) that tested the drug in patients treated with aneurysm clipping found no improvement in clinical outcome in the clazosentan group.221 A similar study in patients treated with coiling (CONSCIOUS-3) was then stopped before completion. A warning or sentinel headache that precedes the aSAH-associated ictus is also reported by 10% to 43% of patients.83,84 This sentinel headache increases the odds of early rebleeding 10-fold.85 Most intracranial aneurysms remain asymptomatic until they rupture. This review does not discuss the multitude of ongoing studies. Blacks and Hispanics have a higher incidence of aSAH than white Americans.6,24,25, Behavioral risk factors for aSAH include hypertension, smoking, alcohol abuse, and the use of sympathomimetic drugs (eg, cocaine). In 4.4% of patients, CTA did not provide enough information to determine the best treatment, and those patients required DSA; 61.4% of patients were referred to endovascular treatment on the basis of CTA; and successful coiling was achieved in 92.6%. In case of intraprocedural rupture, rapid reversal of antiplatelet activity can be attempted by platelet transfusion. A retrospective analysis of 220 patients with subarachnoid haemorrhage, Minor leak before rupture of an intracranial aneurysm and subarachnoid hemorrhage of unknown etiology, The minor leak preceding subarachnoid hemorrhage, Importance of the recognition of a warning leak as a sign of a ruptured intracranial aneurysm, Hypertens as a risk factor for epilepsy after aneurysmal subarachnoid hemorrhage and surgery, Seizures associated with spontaneous subarachnoid hemorrhage, Determining the sensitivity of computed tomography scanning in early detection of subarachnoid hemorrhage, MRI in acute subarachnoid haemorrhage: findings with a standardised stroke protocol, Problems with diagnosis by fluid-attenuated inversion recovery magnetic resonance imaging in patients with acute aneurysmal subarachnoid hemorrhage, Diagnostic value of magnetic resonance imaging in perimesencephalic and nonperimesencephalic subarachnoid hemorrhage of unknown origin, Comparison of 16-row multislice CT angiography with conventional angiography for detection and evaluation of intracranial aneurysms, Detection of aneurysms by 64-section multidetector CT angiography in patients acutely suspected of having an intracranial aneurysm and comparison with digital subtraction and 3D rotational angiography. Determination of aneurysm treatment, as judged by both experienced cerebrovascular surgeons and endovascular specialists, should be a multidisciplinary decision based on characteristics of the patient and the aneurysm. The aim of this guideline is to present current and comprehensive recommendations for the diagnosis and treatment of aneurysmal subarachnoid hemorrhage (aSAH). 1. (Revised recommendation from previous guidelines), Prophylactic hypervolemia or balloon angioplasty before the development of angiographic spasm is not recommended (Class III; Level of Evidence B). This is an important consideration because the observed decrease in case fatality is related to improvements in survival among hospitalized patients with aSAH. 5. This imaging test can detect bleeding in your brain.Your doctor may inject a contrast dye to view your blood vessels in greater detail (CT angiogram). Aggressive control of fever to a target of normothermia by use of standard or advanced temperature modulating systems is reasonable in the acute phase of aSAH (Class IIa; Level of Evidence B). This statement was approved by the American Heart Association Science Advisory and Coordinating Committee on January 30, 2012. The prior aneurysmal subarachnoid hemorrhage (aSAH) guidelines, sponsored by the AHA Stroke Council, were previously issued in 19941 and 2009.2 The 2009 guidelines covered literature through November 1, 2006.2 The present guidelines primarily cover literature published between November 1, 2006, and May 1, 2010, but the writing group has strived to place these data in the greater context of the prior publications and recommendations. 1-800-AHA-USA-1 (New recommendation), Aneurysm rebleeding is associated with very high mortality and poor prognosis for functional recovery in survivors. Complete obliteration of the aneurysm is recommended whenever possible (Class I; Level of Evidence B). Maintenance of euvolemia and normal circulating blood volume is recommended to prevent DCI. In addition to the size and location of the aneurysm and the patient's age and health status, it might be reasonable to consider morphological and hemodynamic characteristics of the aneurysm when discussing the risk of aneurysm rupture (Class IIb; Level of Evidence B). 2012; 43: 1711-1737. Global cerebral edema after subarachnoid hemorrhage: frequency, predictors, and impact on outcome, Prognostic factors for outcome in patients with aneurysmal subarachnoid hemorrhage, Patterns of cerebral infarction in aneurysmal subarachnoid hemorrhage, Impact of medical complications on outcome after subarachnoid hemorrhage, Medical complications of aneurysmal subarachnoid hemorrhage: a report of the Multicenter, Cooperative Aneurysm Study: participants of the Multicenter Cooperative Aneurysm Study, Ruptured intracranial aneurysms: factors affecting the rate and outcome of endovascular treatment complications in a series of 782 patients (CLARITY study), Impact of hospital-related factors on outcome after treatment of cerebral aneurysms, Mortality rates after subarachnoid hemorrhage: variations according to hospital case volume in 18 states, Effect of endovascular services and hospital volume on cerebral aneurysm treatment outcomes, Warning signs in subarachnoid hemorrhage: a cooperative study, Sentinel headaches in aneurysmal subarachnoid haemorrhage: what is the true incidence? Endovascular coiling may receive increased consideration in the elderly (>70 y of age), in those presenting with poor-grade WFNS classification (IV/V) aSAH, and in those with aneurysms of the basilar apex. The value of other calcium antagonists, whether administered orally or intravenously, remains uncertain. Induced hypothermia during aneurysm surgery is not routinely recommended but may be a reasonable option in selected cases (Class III; Level of Evidence B). Monitoring volume status in certain patients with recent aSAH by some combination of central venous pressure, pulmonary wedge pressure, and fluid balance is reasonable, as is treatment of volume contraction with crystalloid or colloid fluids (Class IIa; Level of Evidence B). Table 1. With the increasing use of intravascular stents, the administration of antiplatelet agents (aspirin, clopidogrel, and glycoprotein IIb/IIIa receptor antagonists) during these procedures has become more common. Microsurgical clipping may receive increased consideration in patients presenting with large (>50 mL) intraparenchymal hematomas and middle cerebral artery aneurysms. 13. Two additional medical complications are heparin-induced thrombocytopenia333–335 and deep venous thrombosis. Each subcategory was led by 1 author, with 1 or 2 additional coauthors who made contributions. When followed up on magnetic resonance imaging, larger aneurysms (≥8 mm in diameter) tended to grow more over time,45 which implies a higher risk of rupture. Instructions for obtaining permission are located at http://www.heart.org/HEARTORG/General/Copyright-Permission-Guidelines_UCM_300404_Article.jsp. To purchase additional reprints, call 843-216-2533 or e-mail kelle. In selected patients with giant aneurysms, deep hypothermia with circulatory arrest under cardiopulmonary extracorporeal circulation has been shown to be a feasible and possibly useful technique, but outcome data are lacking.192–196 Transient cardiac pause induced by adenosine has been used to control bleeding from intraoperative aneurysm rupture or to decompress large aneurysms and facilitate aneurysm clip application197,198; however, controlled studies are needed to validate this intervention. 4. Low-volume hospitals (eg, <10 aSAH cases per year) should consider early transfer of patients with aSAH to high-volume centers (eg, >35 aSAH cases per year) with experienced cerebrovascular surgeons, endovascular specialists, and multidisciplinary neuro-intensive care services. 8. aSAH indicates aneurysmal subarachnoid hemorrhage; CTA, computed tomography angiography; DSA, digital subtraction angiography; CT, computed tomography; DSA, digital subtraction angiography; EVD, external ventricular drainage; DCI, delayed cerebral ischemia; and WFNS, World Federation of Neurological Surgeons. A high level of suspicion for aSAH should exist in patients with acute onset of severe headache (Class I; Level of Evidence B). If an aneurysm is detected by CTA, this study may help guide the decision for the type of aneurysm repair, but if CTA is inconclusive, DSA is still recommended (except possibly in the instance of classic perimesencephalic SAH). The use of packed red blood cell transfusion to treat anemia might be reasonable in patients with aSAH who are at risk of cerebral ischemia. DSA with 3-dimensional rotational angiography is indicated for detection of aneurysm in patients with aSAH (except when the aneurysm was previously diagnosed by a noninvasive angiogram) and for planning treatment (to determine whether an aneurysm is amenable to coiling or to expedite microsurgery). 2012;43:1711–1737. Customer Service There are insufficient data on pharmacological strategies and induced hypertension during temporary vessel occlusion to make specific recommendations, but there are instances when their use may be considered reasonable (Class IIb; Level of Evidence C). There is little information in the literature about anesthetic management of patients undergoing endovascular treatment of ruptured cerebral aneurysms.199–201 Generally, the anesthetic principles that apply to open surgical treatment of ruptured cerebral aneurysms also apply to endovascular treatment. 10. Acute hydrocephalus associated with aSAH is usually managed by external ventricular drainage (EVD) or lumbar drainage. Inter- and intraobserver agreement in CT characterization of nonaneurysmal perimesencephalic subarachnoid hemorrhage. Nicardipine may give smoother blood pressure control than labetalol135 and sodium nitroprusside,136 although data showing different clinical outcomes are lacking. Many of these can be found at http://www.strokecenter.org/trials/. Washington University School of Medicine (St. Louis), University of California at San Francisco Medical Center, Micrus Endovascular, >1 y ago, served as DSMB Chair. Weaning EVD over >24 hours does not appear to be effective in reducing the need for ventricular shunting. doi: 10.1056/nejmcp1605827 . Many of these can be found at http://www.strokecenter.org/trials/. Experts in each field were screened for important conflicts of interest and then met by telephone to determine subcategories to evaluate. Between the time of aSAH symptom onset and aneurysm obliteration, blood pressure should be controlled with a titratable agent to balance the risk of stroke, hypertension-related rebleeding, and maintenance of cerebral perfusion pressure. In a retrospective study of 109 patients with proven aSAH, headache was present in 74%, nausea or vomiting in 77%, loss of consciousness in 53%, and nuchal rigidity in 35%.88 As many as 12% of patients die before receiving medical attention. Subarachnoid Hemorrhage Complications. "Guidelines for the management of aneurysmal subarachnoid hemorrhage a guideline for healthcare professionals from the American heart association/American stroke association." This table represents the relationships of writing group members that may be perceived as actual or reasonably perceived conflicts of interest as reported on the Disclosure Questionnaire, which all writing group members are required to complete and submit. Hospital Characteristics and Systems of Care Although the case fatality of aSAH remains high worldwide,5 mortality rates from aSAH appear to have declined in industrialized nations over the past 25 years.9,11,15,58,59 One study in the United States reported a decrease of ≈1% per year from 1979 to 1994.60 Others have shown that case fatality rates decreased from 57% in the mid-1970s to 42% in the mid-1980s,11 whereas rates from the mid-1980s to 2002 are reported to be anywhere from 26% to 36%.6,12,13,18,20,61,62 Mortality rates vary widely across published epidemiological studies, ranging from 8% to 67%.59 Regional variations become apparent when numbers from different studies are compared.

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13. The Hirer shall ensure that all permissions required before the hire item(s) can lawfully be deposited on the site including the permission required under the Highways Act 1971 have been, or will be obtained, before they request the Provider, or direct the Driver to deposit the hire item(s) on the site; and that the said permission will be kept in force during the period of hire and where necessary for up to 3 working days thereafter. The hirer will ensure that all hire item(s) sited on the highways will be lighted and coned in accordance with the terms and conditions of the highways act and the issuing local authority’s demands.

14. The Hirer shall not move the hire item(s) from the site without the consent of the Provider and where necessary the highway authority; and in any case will undertake to notify Skipandwaste.com as soon as is reasonably possible.

15. The Hirer shall ensure:

a) That the Hirer signs a single or multiple consignment transfer note declaring the waste type and that the waste is accurately described when completing the transfer note.

b) Where the waste type does not conform to the description, as specified on the waste transfer note, or is different to that as specified at the time the hire item(s) was ordered, then charges will vary accordingly.

c) Where inert waste loads (soil/hardcore/muck) are ordered and they are found to contain other waste types, in particular mixed builder’s waste materials thus contaminating the load, the hirer will be charged accordingly for the hire tipping charges (typically £82.50 per tonne). In particular the hirer must be aware of the considerable differences in landfill tax rates. Currently £2.50/tonne for inert materials and £82.50/tonne for active waste materials.

d) Where appropriate, waste is only stored in suitable containers.

e) That no liquids, explosives, toxic, or dangerous materials including, but not limited to fibrous asbestos, solvents, minerals or greases will be placed in the hire item(s) without the written consent of the supplier; and that the contents of the hire item(s) when loaded conform to the requirements of S.I.1980/1709 or any re-enactment thereof and the local waste regulation authority with regard omits suitability for disposal as general or special waste as a controlled waste disposal site.

f) If any waste to which the said section applies is placed in any hire item(s) the Hirer will immediately give the notices required by the said section and send copies of such notices to both Skipandwaste.com and the Provider.

g) That no bonded asbestos will be placed, save where the Hirer has given to Skipandwaste.com, a minimum of seven days’ notice of their intentions so to do and obtained the written agreement of Skipandwaste.com and agreed to the charges to be made with regard thereto.

h) No cans, bottles or other liquid containers are placed in the hire item(s) unless they are dry, free from liquid, residues and open for inspection.
i) That no fridges, freezers, vehicle tyres, car/commercial vehicle batteries and any other waste types, which following changes in legislation from time to time may become classified as a special difficult, or hazardous waste type.

16. The Hirer shall ensure from the time that the hire item(s) is deposited until it is picked up again by the Provider/Supplier:-

a) It is properly sited in accordance with any relevant permission and that all conditions thereof are observed and performed at all times.

b) It is properly coned where necessary during the hours of daylight and coned and lighted during the hours of darkness.

c) No fires are lit in, and no corrosive acid or noxious substance, liquid cement or concrete placed in the hire item(s).

d) It is filled no higher than the top of its sides and in such a manner as to prevent spillage of material, both whilst the container is stationary, or in transit. Where hire item(s) are located on public or third party property and waste is accumulated for any reason whatsoever in the immediate proximity of the hire item(s), Skipandwaste.com reserves the right to supply a further hire item(s) to contain the surplus material and to transfer the same to the hire item(s) and to debit the Hirer with the reasonable costs of so doing.

e) It suffers no damage except fair wear and tear. All damage by fire, vandalism or other means, the Hirer will reimburse the Provider all costs for either replacement or repair; unless the Hirer has taken out an insurance policy with Skipandwaste.com, or provides their own insurance to cover all loss and/or damage whilst the hire item(s) are under the Hirer’s care.

f) No danger is caused by the hire item(s) or its contents to any third party and in particular, but without limitation thereto, to children.

g) No unauthorised removal of the hire item(s) shall take place by the hirer or a 3rd party contractor without the prior consent of the provider. The hirer will be debited all reasonable costs incurred in returning the hire item(s), or in cases where the hire item(s) is deemed lost or stolen the hirer will reimburse the Provider in full. Please note that many insurance policies will not cover theft of hire item(s).

17. Notwithstanding the terms of condition 15 it shall be the Hirer’s duty to notify the Provider of, and the Provider’s responsibility to ensure compliance with, any condition imposed by a highway authority relating to the marking of the hire item(s) with reflective paint.

18. Except as specifically otherwise agreed in writing the Hirer shall fill the hire item(s) within the period of hire as specified by the Provider and shall inform Skipandwaste.com in good time of its readiness for collection or replacement. The Hirer shall ensure that, from the time when collection of the hire item(s) is due to take place until the same is collected, there is left a clear space at one end of the container to terminate the hiring of the hire item(s) the minimum notice period shall be one clear working day.

19. The Provider may arrange the removal or repositioning of the hire item(s) if required at any time to do so by a highway authority or constable in uniform under Section 140 of the Highway Act 1980. The Hirer shall be responsible for the reasonable additional cost thereof on the part of the Provider or Supplier.

20. It is the responsibility of the hirer’s representative on site to keep the hirer’s copy of the ‘Proof of
Delivery’ ticket. Any copies required at a later date will be subject to a £30 administration charge.

21. Except as specifically otherwise agreed in writing, the Provider agrees to dispose of the contents of the hire item(s) as shall be in accordance with the terms of the contract. The Hirer agrees that they will pay the Provider’s reasonable charges of dealing with any of the contents of any hire item(s) which do not comply with the terms of this contract.

22. Risk and Title: The risk in relation to any hire item(s) supplied pursuant to this Contract shall pass to the Hirer upon delivery, in accordance with the Hirer’s request or direction and shall remain with the Hirer until the hire item(s) are collected by the Provider. Title shall not transfer to the Hirer under any circumstances.

23. Where the Service is provided under a consumer transaction as defined by the Consumer Transaction (Restriction on Statements) order 1976, the statutory rights of the Hirer are not affected by these conditions.

24. It is specifically provided and agreed that any compensation &/or damages payment in respect of any claim or claims arising out of, or in connection with, the terms of this contract for any reason whatsoever and howsoever arising, shall not amount in the aggregate to more than the cost of the provision of the service by the Provider, or that part of the Service giving rise to such claim, and in any event not more than £1000; and Skipandwaste.com and any other person entitled to the benefit of this contract shall have no further liability to the Hirer. Except in respect of death or personal injury caused by the negligence of Skipandwaste.com or any other person entitled to the benefit of this contract, Skipandwaste.com or such party shall not be liable to the Hirer by reason of any representation, or any implied warranty, condition or other term, or any duty at common law, or under the expressed terms of this contract, for any consequential loss or damage (whether for loss of profit or otherwise), costs, expenses or other claims for consequential or incidental compensation whatsoever (and whether caused by the negligence of Skipandwaste.com or any other party entitled to the benefit of this contract, their employees, or agents, or otherwise) which arise out of, or in connection with the supply of the service, except as expressly provided in these conditions.

25. Skipandwaste.com shall not be liable to the Hirer or be deemed to be in breach of the contract by reason of any delay in performing, or any failure to perform, any of the provider’s, supplier’s, or co-ordinator’s obligations in relation to the service, if the delay or failure was due to force majeure.

26. Insolvency of Hirer:

a) This clause applies if:

i) The Hirer makes any voluntary arrangement with its creditors or becomes subject to an administration order or (being an individual or firm) becomes bankrupt or (being a company) goes into liquidation (otherwise than for the purposes of amalgamation or
reconstruction); or ii) an encumbrance takes possession, or a receiver is appointed, or any of the property or assets of the Hirer, or

iii) The Hirer ceases or threatens to cease; to carry on business; or

iv) Skipandwaste.com reasonably apprehends that any of the events mentioned above is about to occur in relation to the Hirer and notifies to the Hirer accordingly.

b) If this clause applies, then without prejudice to any other right or remedy available to Skipandwaste.com, Skipandwaste.com shall be entitled to cancel the contract or suspend any further deliveries under the Contract without any liability to the Hirer, and if the Services have been provided but not paid for, the price shall become immediately due and payable, not withstanding any previous agreement or arrangement to the contrary.

27. Refund Policy

27.1 Application for refunds must be sent directly to Skipandwaste.com, in writing, addressed to the Customer Service Manager.

28. Cancellation Policy – Cancellation of Hire. If the hirer chooses to cancel the hire, the following charges will be levied:

More than 4 days’ notice – 10% of total hire charge

1-3 days’ notice – 50% of total hire charge

Less than 24 hours’ notice – 100% of total hire charge

Please note cancellation charges apply on all orders once instruction to deliver has been taken.

Additional Terms & Conditions for Domestic Private Hire

The hirer is responsible for ensuring the position for hire item(s) delivery has a clear access. Blocked access due to abandoned vehicles or materials resulting in failed delivery/collection will incur standing time and or an aborted delivery charge (known generally as a wasted journey fee). The Hirer is responsible for theft or damage to hire item(s) whilst on hire & until hire item(s) is removed by the hire item(s) owner.

Skipandwaste.com cannot accept any liability for any costs incurred through damage to the hirer’s driveway or other property whilst delivering or collecting the hire item(s) off the public highway.

The hire item(s) vehicle is invited off the highways onto private property at the hirer’s own risk, and is a separate arrangement to be confirmed with the Provider. Please note that we draw your attention to the fact that tarmac, block paved, and pattern-imprinted concrete driveways are at most risk.

The Hirer is also responsible for pointing out low lying cables, narrow entrance pillars, manhole covers, and any other potential risks or obstructions to Hire item(s) or the driver, prior to the hire item(s) delivery.
The local authority may require the lighting and coning of all on-road hire item(s) and, unless otherwise advised, it is necessary to obtain the necessary council consent with a road permit. Hirers should note that the fines for failure to light and cone a skip correctly vary according to the regulations set by the permit issuing authority. Hirers are advised to consult https://www.gov.uk/apply-skip-permit prior to completing the request of the hire item(s). Skipandwaste.com can assist in the facilitation of the provision of a valid permit. Please be advised that there will be an administration charge of £15 per permit/paperwork application.

In all cases delivery and collection times are given for guidance only and Skipandwaste.com accepts no liability for any costs incurred due to delays in delivery/collection; or failure to deliver on the preferred delivery date, or at the preferred time due to unforeseen circumstances. In all circumstances invoices exclude exceptional conditions such as force majeure.

In Addition to the above terms

1 INTERPRETATION

1.1 In these conditions the following words have the following meanings:
“Contract” means a contract which incorporates these conditions and made between the Customer and the Supplier for the hire of Hire Goods and/or the sale of Products;
“Customer” means the person, firm, company or other organisation hiring Hire Goods;
“Deposit” means any advance payment required by Skipandwaste.com in relation to the Hire Goods which is to be held as security by Skipandwaste.com;
“Force Majeure” means any event outside a party’s reasonable control including but not limited to acts of God, war, flood, fire, labour disputes, strikes, sub-contractors, lock-outs, riots, civil commotion, malicious damage, explosion, terrorism, governmental actions and any other similar events;
“Hire Goods” means any machine, article, tool, skip, ‘wheelie bin’ and/or device together with any accessories specified in a Contract, which are hired to the Customer;
“Hire Period” means the period commencing when the Customer holds the Hire Goods on hire (including Saturdays, Sundays and Bank Holidays) and ending upon the happening of any of the following events: the physical return of the Hire Goods by the Customer into the Provider’s possession; or the physical repossession or collection of Hire Goods by the Provider;
“Liability” means liability for any and all damages, claims, proceedings, actions, awards, expenses, costs and any other losses and/or liabilities;
“Products” means the products sold to the Customer by Skipandwaste.com; “Rental” means the Provider’s charging rate for the hire of the Hire Goods which is current from time to time during the Hire Period;
“Provider” means the appointed company arranged by Skipandwaste.com to fulfil the terms of the contract and will include its employees, servants, agents and/or duly authorised representatives;
“Services” means the services and/or work (if any) to be performed by Skipandwaste.com for the Customer in conjunction with the hire of Hire Goods including any delivery and/or collection service for the Hire Goods.

2 BASIS OF CONTRACT

2.1 Hire Goods are hired subject to them being available for hire to the Customer at the time required by the Customer. Skipandwaste.com will not be liable for any loss suffered by the Customer as a result of the Hire Goods being unavailable for hire where the Hire Goods are unavailable due to circumstances beyond Skipandwaste.com’s control.
2.2 Where hire of the Hire Goods is to a Customer who is an individual and the hire would be covered by the Consumer Credit Act 1974 the duration of the Hire Period shall not exceed 3 months, after which time the Contract shall be deemed to have automatically terminated.
2.3 Nothing in this Contract shall exclude or limit any statutory rights of the Customer which may not be excluded or limited due to the Customer acting as a consumer. For further information about your statutory rights contact your local authority Trading Standards Department or Citizen’s Advice Bureau.

3 PAYMENT

3.1 The amount of any Deposit, Rental and/or charges for any Services shall be as quoted to the Customer or otherwise as shown in Skipandwaste.com’s online quotation service. Where a Deposit is required for the Hire Goods it must be paid in advance of the Customer hiring the Hire Goods. Skipandwaste.com may also require an initial payment on account of the Rental in advance of the Customer hiring the Hire Goods.
3.2 The Customer shall pay the Rental, charges for any Services, monies for any Products and/or any other sums payable under the contract to Skipandwaste.com at the time and in the manner agreed. Skipandwaste.com’s prices are, unless otherwise stated, exclusive of any applicable VAT for which the Customer shall additionally be liable.
3.3 Payments by the Customer on time under the Contract are an essential condition of the Contract. Payment shall not be deemed to be made until Skipandwaste.com has received either cash or cleared funds in respect of the full amount outstanding.
3.4 Skipandwaste.com reserves the right to withhold payment for any requested hire item, until the appropriate certification and paperwork has been received by Skipandwaste.com. This is usually, but not limited to, Waste Transfer Note, Certification of Waste type and accurate weight thereof.

4 RISK AND TITLE OWNERSHIP AND INSURANCE

4.1 Risk in the Hire Goods and any Products will pass immediately to the Customer when they leave the physical possession or control of the Provider. Title will not transfer to the Customer in any case.
4.2 Risk in the Hire Goods will not pass back to the Provider from the Customer until the Hire Goods are back in the physical possession of the Provider. This shall apply even if the Provider has agreed to cease charging the Rental.
4.3 Ownership of the Hire Goods remains at all times with the Provider. The Customer has no right, title or interest in the Hire Goods except that they are hired to the Customer.
4.4 The Customer must not deal with the ownership or any interest in the Hire Goods. This includes but is not limited to selling, assigning, mortgaging, pledging, charging, securing, hiring, withholding, exerting any right to withhold, disposing of and/or lending.
4.5 The Provider may provide reasonably priced insurance in respect of the Hire Goods at additional cost to the Rental. Alternatively the Provider may require the Customer to insure the Hire Goods on such reasonable terms and for such reasonable risks as the Provider may specify. The proceeds of any such insurance shall be held by the Customer in trust for the Provider and be paid to the Provider on demand. The Customer must not compromise any claim in respect of the Hire Goods and/or any associated insurance without the Provider’s written consent.

5 DELIVERY, COLLECTION AND SERVICES

5.1 It is the responsibility of the Customer to collect the Hire Goods from the Provider and return them to the Provider at the end of the Hire Period. If the Provider agrees to deliver or collect the Hire Goods to and/or from the Customer it will do so at its standard delivery cost and such delivery and/or collection will form part of the Services.
5.2 Where the Provider provides Services the persons performing the Services are servants of the Customer and once the Customer instructs such person they are under the direction and control of the Customer. The Customer shall be solely responsible for any instruction, guidance and/or advice given by the Customer to any such person and for any damage which occurs as a result of such persons following the Customer’s instructions, guidance and/or advice except to the extent that the persons performing the Services are negligent.
5.3 The Customer will allow and/or procure sufficient access to and from the relevant site and procure sufficient unloading space, facilities, equipment and access to power supplies and utilities for the Provider’s employees, subcontractors and/or agents to allow them to carry out the Services. The Customer will ensure that the site where the Services are to be performed is, where necessary, cleared and prepared before the Services are due to commence.
5.4 If any Services are delayed, postponed and/or are cancelled due to the Customer failing to comply with its obligations the Customer will be liable to pay the Provider’s additional standard charges from time to time for such delay, postponement and/or cancellation except where the Customer is acting as a consumer and the delay is due to a Force Majeure event.

6 CARE OF HIRE GOODS

6.1 The Customer shall:-
6.1.1 not remove any labels from and/or interfere with the Hire Goods, their working mechanisms or any other parts of them and take reasonable care of the Hire Goods and only use them for their proper purpose in a safe and correct manner in accordance with any operating and/or safety instructions provided or supplied to the Customer;
6.1.2 Notify the Provider immediately after any breakdown, loss and/or damage to the Hire Goods;
6.1.3 Take adequate and proper measures to protect the Hire Goods from theft, damage and/or other risks;
6.1.4 Notify the Provider of any change of its address and upon the Provider’s request provide details of the location of the Hire Goods;
6.1.5 Permit the Provider at all reasonable times to inspect the Hire Goods including procuring access to any property where the Hire Goods are situated;
6.1.6 keep the Hire Goods at all times in its possession and control and not to remove the Hire Goods from the United Kingdom without the prior written consent of the Provider;
6.1.7 be responsible for the conduct and cost of any testing, examinations and/or checks in relation to the Hire Goods required by any legislation, best practice and/or operating instructions except to the extent that the Provider has agreed to provide them as part of any Services;
6.1.8 Not do, or omit to do, anything which will, or may be deemed to, invalidate any policy of insurance related to the Hire Goods, which is notified to the Customer;
6.1.9 not continue to use Hire Goods where they have been damaged and will notify Skipandwaste.com and the Provider immediately if the Hire Goods are involved in an accident resulting in damage to the Hire Goods, other property and/or injury to any person; and
6.1.10 where the Hire Goods require fuel, oil and/or electricity ensure that the proper type and/or voltage is used and that, where appropriate, the Hire Goods are properly installed by a qualified and competent person.
6.2 The Hire Goods must be returned by the Customer in good working order and condition (fair wear and tear excepted) and in a clean condition together with all insurance policies, licences, registration and other documents relating to the Hire Goods.

7 BREAKDOWN

7.1 The Provider will at its own cost carry out all routine maintenance and repairs to the Hire Goods during the Hire Period and all repairs which are required due to fair wear and tear and/or an inherent fault in the Hire Goods. The Customer will be responsible for the cost of all repairs necessary to Hire Goods during the Hire Period which arise otherwise than as a result of fair wear and tear, an inherent fault and/or the negligence of the Supplier while carrying out routine maintenance and/or repairs.
7.2 The Customer must not repair or attempt to repair the Hire Goods unless authorised to do so in writing by Skipandwaste.com or the Provider.

8 LOSS OR DAMAGE TO THE HIRE GOODS

8.1 If the Hire Goods are returned in damaged, unclean and/or defective state except where due to fair wear and tear and/or an inherent fault in the Hire Goods the Customer shall be liable to pay the Provider for the cost of any repair and/or cleaning required to return the Hire Goods to a condition fit for re-hire and to pay the Rental, in accordance with the provisions of clause 8.3, until such repairs and/or cleaning have been completed.
8.2 The Customer will pay to the Provider the replacement cost of any Hire Goods which are lost, stolen and/or damaged beyond economic repair during the Hire Period less the amount paid to the Provider under any policy of insurance taken out in accordance with these conditions.
8.3 The Customer shall pay the Rental for the Hire Goods up to and including the date it notifies Skipandwaste.com that the Hire Goods have been lost, stolen and/or damaged beyond economic repair. From that date until Skipandwaste.com has replaced such Hire Goods the Customer shall pay, as a genuine pre-estimate of lost rental profit, a sum as liquidated damages being equal to two thirds of the Rental that would have applied for such Hire Goods for that period. Skipandwaste.com shall use its reasonable commercial endeavours to purchase replacements for such Hire Goods as quickly as possible using the monies paid under clause 8.2 above.

9 TERMINATION BY NOTICE

9.1 If the Hire Period has a fixed duration, subject to the provisions of Section 10 neither the Customer nor Skipandwaste.com shall be entitled to terminate the Contract before the expiry of that fixed period unless agreed with the other party.
9.2 If the Hire Period does not have a fixed duration either of the Customer or Skipandwaste.com is entitled to terminate the Contract upon giving to the other party any agreed period of notice.
9.3 If no period of notice has been agreed or specified the Customer may terminate the Hire Period by the physical return of the Hire Goods to the Provider and Skipandwaste.com shall be entitled to terminate the hire of the Hire Goods by giving not less than 14 days’ notice to the Customer.

10 DEFAULT

10.1 If the Customer:-
10.1.1 Fails to make any payment to Skipandwaste.com when due without just cause;
10.1.2 breaches the terms of the Contract and, where the breach is capable of remedy, has not remedied the breach within 14 days of receiving notice requiring the breach to be remedied;
10.1.3 Persistently breaches the terms of the Contract;
10.1.4 provides incomplete, materially inaccurate or misleading facts and/or information in connection with the Contract;
10.1.5 pledges, charges or creates any form of security over any Hire Goods, or ceases or threatens to cease to carry on business, or proposes to compound with its creditors, applies for an interim moratorium in respect of claims and/or proceedings, any distress, execution or other legal process is levied on any property of the Customer, has a Bankruptcy Petition presented against it or the Customer takes or suffers any similar action in any jurisdiction;
10.1.6 being a company, enters into voluntary or compulsory liquidation, has a receiver, administrator or administrative receiver appointed over all or any of its assets, any attachment order is made against the Customer, any distress, execution or other legal process is levied on any property of the Customer or the Customer takes or suffers any similar action in any jurisdiction;
10.1.7 appears reasonably to Skipandwaste.com due to the Customer’s credit rating to be financially inadequate to meet its obligations under the Contract; and/or
10.1.8 appears reasonably to Skipandwaste.com to be about to suffer any of the above events; then Skipandwaste.com shall have the right, without prejudice to any other remedies, to exercise any or all of the rights set out in clause 10.2 below.

10.2 If any of the events set out in clause 10.1 above occurs in relation to the
Customer then:-
10.2.1 Except where the Customer is acting as a consumer, Skipandwaste.com may enter, without prior notice, any premises of the Customer (or premises of third parties with their consent) where Hire Goods owned by Skipandwaste.com may be and repossess any Hire Goods;
10.2.2 Skipandwaste.com may withhold the performance of any Services and cease any Services in progress under this and/or any other Contract with the Customer;
10.2.3 Skipandwaste.com may immediately cancel, terminate and/or suspend without Liability to the Customer the Contract and/or any other contract with the Customer; and/or
10.2.4 All monies owed by the Customer to Skipandwaste.com shall immediately become due and payable.

10.3 Any repossession of the Hire Goods shall not affect Skipandwaste.com’s right to recover from the Customer any monies due under the Contract and/or any damages in respect of any breach which occurred prior to repossession of the Hire Goods.

10.4 Upon termination of the Contract the Customer shall immediately:
10.4.1 return the Hire Goods to Skipandwaste.com and/or Skipandwaste.com’s nominated Provider; or make the Hire Goods available for collection by Skipandwaste.com’s nominated Provider as requested by the Provider; and
10.4.2 Pay to Skipandwaste.com all arrears for Rentals, Charges for any Services, monies for any Products and/or any other sums payable under the Contract.

11 LIMITATIONS OF LIABILITY

11.1 All warranties, representations, terms, conditions and duties implied by law relating to fitness, quality and/or adequacy are excluded to the fullest extent permitted by law.
11.2 If Skipandwaste.com is found to be liable in respect of any loss or damage to the Customer’s property the extent of Skipandwaste.com’s Liability will be limited to the retail cost of replacement of the damaged property.
11.3 Any defective Hire Goods must be returned to Skipandwaste.com’s nominated Provider for inspection if requested by Skipandwaste.com’s nominated Provider, before Skipandwaste.com’s nominated Provider will have any Liability for defective Hire Goods.
11.4 Skipandwaste.com shall have no Liability to the Customer if, without just cause, any monies due in respect of the Hire Goods and/or the Services has not been paid in full by the due date for payment.
11.5 Skipandwaste.com shall have no Liability for additional damage, loss, liability, claims, costs or expenses caused, or contributed to, by the Customer’s continued use of defective Hire Goods and/or Services after a defect has become apparent, or suspected, or should reasonably have become apparent to the Customer.
11.6 The Customer shall give Skipandwaste.com a reasonable opportunity to remedy any matter for which Skipandwaste.com is liable, before the Customer incurs any costs and/or expenses in remedying the matter itself. If the Customer does not do so Skipandwaste.com shall have no Liability to the Customer in this regard.
11.7 Skipandwaste.com shall have no Liability to the Customer to the extent that the Customer is covered by any policy of insurance arranged as a result of the Contract and the Customer shall ensure that the Customer’s insurers waive any and all rights of subrogation they may have against Skipandwaste.com.
11.8 Skipandwaste.com shall have no Liability to the Customer for any:-
11.8.1 Consequential losses (including loss of profits and/or damage to goodwill and/or reputation);
11.8.2 Economic and/or other similar losses;
11.8.3 Special damages and indirect losses; and/or
11.8.4 Business interruption, loss of business, contracts and/or opportunity.

11.9 Skipandwaste.com’s total Liability to the Customer under and/or arising in relation to any Contract shall not exceed 5 times the amount of the Rental and charges for Services (if any) under that Contract or the sum of £1,000 whichever is the higher. To the extent that any Liability of Skipandwaste.com to the Customer would be met by any insurance of Skipandwaste.com, then the Liability of Skipandwaste.com shall be extended to the extent that such Liability is met by such insurance.

11.10 Each of the limitations and/or exclusions in this Contract shall be deemed to be repeated and apply as a separate provision for each of:
11.10.1 Liability for breach of contract;
11.10.2 Liability in tort (including negligence); and
11.10.3 Liability for breach of statutory and/or common law duty; except clause 11.9 above, which shall apply once only in respect of all the said types of Liability.

11.11 Nothing in this Contract shall exclude or limit the Liability of Skipandwaste.com for death or personal injury due to Skipandwaste.com’s negligence, nor exclude or limit any other type of Liability which it is not permitted to exclude or limit as a matter of law.

12 GENERAL

12.1 Upon termination of the Contract the provisions of clauses 3.2, 3.4, 3.5, 8.1, 8.2, 8.3 and Section 6 shall continue in full force and effect.

12.2 Each hire of an item of Hire Goods shall form a distinct Contract which shall be separate to any other Contract relating to other Hire Goods.

12.3 The Customer shall be liable for the acts and/or omissions of its employees, agents, servants and/or subcontractors as though they were its own acts and/or omissions under this Contract.

12.4 The Customer agrees to indemnify and keep indemnified Skipandwaste.com against any and all losses, lost profits, damages, claims, costs (including legal costs on a full indemnity basis), actions and any other losses and/or liabilities suffered by the Supplier and arising from or due to any breach of contract, any tortuous act and/or omission and/or any breach of statutory duty by the Customer.

12.5 No waiver by Skipandwaste.com of any breach of this Contract shall be considered as a waiver of any subsequent breach of the same provision, or any other provision. If any provision is held by any relevant competent authority to be part of the validity of the other provisions of this Contract and the remainder of the affected provision shall be unaffected and shall remain in full force and effect.

12.6 Skipandwaste.com shall have no Liability to the Customer for any delay and/or non-performance of a Contract to the extent that such delay is due to any Force Majeure events. If Skipandwaste.com is affected by any such event then time for performance shall be extended for a period equal to the period that such event or events delayed such performance.

12.7 All third party rights are excluded and no third parties shall have any rights to enforce the Contract.

This shall not apply to any finance company with whom Skipandwaste.com has an outstanding finance agreement relating to the Hire Goods. Such finance company shall, subject to Skipandwaste.com’s consent, have the right to enforce this Contract as if they were the Supplier. This Contract is governed by and interpreted in accordance with English law and the parties agree to submit to the non-exclusive jurisdiction of the English courts.

13 ADDITIONAL CONDITIONS

13.1 Skipandwaste.com may insert and present for payment any balance due and unpaid where the Customer has signed a blank or nil value debit or credit card voucher. The Supplier may also process interim payments by credit or debit card at any stage of the Contract.