Fillable CITY OF YORBA LINDA-FILM PERMIT (City of Yorba Linda)

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CITY OF YORBA LINDA-FILM PERMIT (City of Yorba Linda)

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The CITY OF YORBA LINDA-FILM PERMIT (City of Yorba Linda) form is 6 pages long and contains:

  • 5 signatures
  • 28 check-boxes
  • 116 other fields

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U.S.A. forms for City of Yorba Linda

BROWSE CITY OF YORBA LINDA (CA) FORMS

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CITY OF YORBA LINDA-FILM PERMIT
4845 Casa Loma Avenue
Yorba Linda, CA 92886
Date Rec’d ___________
Organization/Business: ______________________________________________________________________________________
Contact Person: ______________________________________________________________________________________
Address: ______________________________________________________________________________________
______________________________________________________________________________________
Phone Number: ____________________ FAX Number: ____________________Email:____________________________________
Location of Filming/Address: __________________________________________________________________________________
__________________________________________________________________________________
Date(s) and Hours of Filming: ___________________________________________________________________________________
Describe the filming event:
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
Applicant’s Name/Signature:
_______________________________________________________
Print Name
_______________________________________________________ ____________________________
Signature Date
***********************************************************************************************************
For Department Use Only
Conditions of Approval:
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
The film application was reviewed and Approved / Denied.
_______________________________________________________ ____________________________
Signature Mark Aalders, Assistant to the City Manager Date
(714) 961-7106
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CITY OF YORBA LINDA
FILM PERMIT CHECKLIST
1. ____ Film Permit Fee in the amount of $250.00 made payable to City of Yorba Linda.
2. ____ Obtain a Certificate of Insurance proving general liability coverage of $1,000,000 per occurrence. The Certificate must list the
City of Yorba Linda as additional insured (in the policy or in an endorsement) and it shall be shall be endorsed as follows:
“The City, its officials, officers, employees, agents, and volunteers shall be additional insureds with regard to liability and
defense of suits or claims arising out of the use of this film permit.”
The general liability coverage must also include a primary/non-contributory endorsement.
3. ____ Sign the appropriate Hold Harmless and Indemnity Agreement(s).
4. ____ Provide evidence such as a notice and signature sheet to City of Yorba Linda that all affected residents and businesses in the
filming area have been notified and approve of the film shoot. You may use the lines below for this purpose or create your
own flyer for distribution and signatures.
Resident/Business Address Authorization/Signature
______________________________ _________________________________ ____________________________
______________________________ _________________________________ ____________________________
______________________________ _________________________________ ____________________________
______________________________ _________________________________ ____________________________
______________________________ _________________________________ ____________________________
______________________________ _________________________________ ____________________________
5. ____ Identify all equipment that will be used in the filming with particular emphasis on the number of cars and trucks that will be
brought to the filming location.
_____________________________________________ _________________________________________________
_____________________________________________ _________________________________________________
_____________________________________________ _________________________________________________
_____________________________________________ _________________________________________________
_____________________________________________ _________________________________________________
6. ____ Prepare and submit a Parking Diagram to City of Yorba Linda which must be approved by the Traffic Engineer.
7. ____ Will your filming in any way disrupt or impede the flow of traffic? Yes _____ No _____
If yes, please complete the attached “Traffic Control Checklist”.
8.____ Are you filming in a City park? Yes _____No _____
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Call the Parks and Recreation Department at (714) 961-7160 to make a reservation and/or to ensure there is no scheduling
conflict. Upon approval, prepare and submit a park sketch/diagram(s) as an attachment to this film permit. The park diagram
must be approved by the Parks and Recreation Superintendent.
______________________________________________
Parks & Recreation Department Authorization
9.____ Do you require a noise permit (sound effects, music, etc.)? Yes _____No _____
Call the City Clerk’s Office at (714) 961-7150 to obtain a noise permit application.
______________________________________________
City Clerk’s Office Authorization
10.____ Do you require a special events permit (500 people or more on-site for the film shoot)? Yes _____No _____
Call the Community Preservation Division at (714) 961-7136 to obtain a special events application.
______________________________________________
Community Preservation Division Authorization
11.____ Do you require law enforcement presence for security purposes? Yes _____No _____
Orange County Sheriff’s Department (OCSD) approval as needed. OCSD will provide security if specifically requested for
the film shoot. The applicant will be responsible for paying for all OCSD costs.*
______________________________________________
OCSD Authorization
12.____ Do you require fire department presence for any fire scenes, incendiary devices, fireworks, etc.? Yes _____No _____
Orange County Fire Authority (OCFA) approval as needed. OCFA may require additional forms. The applicant will be
responsible for paying all OCFA costs.*
______________________________________________
OCFA Authorization
*Public safety agencies contact numbers (Dial 9-1-1 in an emergency):
Orange County Fire Authority
1 Fire Authority Rd., Irvine, CA 92602
(714) 573-6000
Yorba Linda Police Services Facility (OCSD)
20994 Yorba Linda Boulevard (located at Arroyo Park)
Monday through Friday, 8am to 5pm
(714)779-7098
CITY OF YORBA LINDA
TRAFFIC CONTROL CHECKLIST
1. ____
Describe the dates, times, and streets that will be affected by the filming:
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
2. ____ Complete and submit an Encroachment Permit Application to the City of Yorba Linda Engineering Department.
3. ____ Prepare and submit a Traffic Management Plan including the barricading and signing to be used. The Traffic Management
Plan must be approved by the Traffic Engineer.
______________________________________________
Engineering Department Authorization
4. ____ Orange County Sheriff’s Department (OCSD) approval as needed. OCSD will provide traffic control if specifically
requested for the film shoot. The applicant will be responsible for paying for all OCSD costs.
______________________________________________
OCSD Authorization
CITY OF YORBA LINDA
HOLD HARMLESS AND INDEMNITY AGREEMENT
(Company Name) _______________________________agrees to defend, indemnify, and hold harmless City of Yorba Linda, its elected
officials, officers, employees, agents and volunteers from any and all actual or alleged claims, demands, causes of action,
liability, loss, damage, or injury, to property or persons, including wrongful death, whether imposed by a court of law or by
administrative action of any federal, state, or local governmental body or agency, arising out of or incident to any acts,
omissions, negligence, or willful misconduct of (Company Name)_______________________________, its personnel,
employees, agents, or contractors in connection with or arising out of use of this film permit. This indemnification includes,
without limitation, the payment of all penalties, fines, judgments, awards, decrees, attorneys’ fees, and related costs or expenses,
and the reimbursement of City of Yorba Linda, its elected officials, officers, employees, and/or agents for all legal expenses
and costs incurred by each of them. This indemnification excludes only such portion of any claim, demand, cause of action,
liability, loss, damage, penalty, fine, or injury, to property or persons, including wrongful death, which is caused solely and
exclusively by the negligence or willful misconduct of City of Yorba Linda as determined by a court or administrative body of
competent jurisdiction.
(Company Name) _______________________________’s obligation to indemnify shall survive the expiration or termination of this
film permit, and shall not be restricted to insurance proceeds, if any, received by Agency, its elected officials, officers,
employees, agents or volunteers.
(Company Name)______________________________agrees to waive all subrogation rights against the City of Yorba Linda.
_______________________________ _______________________________
Signature Title
Representing: _______________________________
Company Name
_______________________________
_______________________________
Address
Date: ________________
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CITY OF YORBA LINDA
HOLD HARMLESS AND INDEMNITY AGREEMENT V.2
I, _______________________________ , an employee of (Company Name) _______________________________agree to defend,
indemnify, and hold harmless City of Yorba Linda, its elected officials, officers, employees, agents and volunteers from any
and all actual or alleged claims, demands, causes of action, liability, loss, damage, or injury, to property or persons, including
wrongful death, whether imposed by a court of law or by administrative action of any federal, state, or local governmental body
or agency, arising out of or incident to any acts, omissions, negligence, or willful misconduct of (Company
Name)_______________________________, its personnel, employees, agents, or contractors in connection with or arising out
of use of this film permit. This indemnification includes, without limitation, the payment of all penalties, fines, judgments,
awards, decrees, attorneys fees, and related costs or expenses, and the reimbursement of City of Yorba Linda, its elected
officials, officers, employees, and/or agents for all legal expenses and costs incurred by each of them. This indemnification
excludes only such portion of any claim, demand, cause of action, liability, loss, damage, penalty, fine, or injury, to property
or persons, including wrongful death, which is caused solely and exclusively by the negligence or willful misconduct of City
of Yorba Linda as determined by a court or administrative body of competent jurisdiction.
(Company Name) _______________________________’s obligation to indemnify shall survive the expiration or termination of this
film permit, and shall not be restricted to insurance proceeds, if any, received by Agency, its elected officials, officers,
employees, agents or volunteers.
I, ______________________________agree to waive all subrogation rights against the City of Yorba Linda.
_______________________________ _______________________________
Signature Title
Representing: _______________________________
Company Name
_______________________________
_______________________________
Address
Date: ________________
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CITY OF YORBA LINDA-FILM PERMIT (City of Yorba Linda)

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Completed 5 August 2020

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