Fillable City Of Mountain View Photography and Film Permitting (City of Mountain View)

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City Of Mountain View Photography and Film Permitting (City of Mountain View)

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  • 47 check-boxes
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City Of Mountain View
Photography and Film Permitting Application
City Manager's Office | 500 Castro St., Mountain View, CA 94040
city.mgr@mountainview.gov | (650) 903-6301 | Fax: (650) 962-0384
(1) Submission of Permit Application
QTY
(6) Fees Code: FILM
Completed packet with signatures must be returned with all forms 10 business days before production.
On-Location Contact: ____________________ On Location Cell (required):____________________
Title or Product (required): ____________________________________________________________
(3) Project Details
Project Description (required): _________________________________________________________
(4) Project Type
Mark all that apply to project.
TV Series/Pilot
Commercial
Corporate
1A) Please email or fax a copy of this application for initial review.
1B) Send entire document with original signature. Final approval requires original signature.
List talent (if applicable): ______________________________________________________________
(2) Contacts
Company/Photographer Name: ________________________________________________________
Other (please specify): _______________________
(5) Production Vehicle(s) (If applicable)
You will pay ONE fee per day.
$125 Photography (High-Impact)
*City Facility Rental
Fees must also be paid
as applicable
$250 Commercial/Corporate/Short/Web
$350 Feature Film/Documentary
Type/Length/Size
Total # of Days: ______________________ Total Due:_______________________________________
Application Date: ______________
Packets received less than 10 business days before production may be denied.
Please review FAQ prior to completing film application.
Project Date (required): ______________________________________________________________
710100-4________
Address: __________________________________________ City: ____________________________
State:___________________ Zip Code: _______________ Phone: ___________________________
Application Contact: _______________________ Contact Email: _____________________________
Contact Phone: __________________________ Location Manager: __________________________
Director: _______________________________ Producer: __________________________________
Feature Film
Documentary
Photography (High-Impact)
Photography (Low-Impact)
Educational/Student Project
Website/Design
Event
Non-Profit
Film Short
1
City of Mountain View
Insurance and Locations Pages
City Manager's Office | 500 Castro St., Mountain View, CA 94040
city.mgr@mountainview.gov | (650) 903-6301 | Fax: (650) 962-0384
Please be certain to fill out and return all additional forms indicated.
(8) Wavier and Release Form
(Office Use Only) Received By: Date:
Event Date: # of Days: Total Paid: Application Complete (Y/N?):
CMO Risk Management CSD PWD (Traffic) PD FD
(Office Use Only) Sidewalks Only Disability Access Parking per PD
May Not Control Sidewalks Public Right of Way
May Not Control Streets Camera: Tripod only / Handheld
Comments:
Please note all shoots require liability insurance, endorsements, and liability waiver release forms.
(7) Insurance
Additional Comments:
Additional Insured Endorsement*
If you have any questions regarding insurance forms please contact Risk Management at (650) 903-6060.
Hold Harmless Voluntary Assumption of Risk, Release of Liability, and Indemnification Agreement
* The City of Mountain View, it's officials, officers, employees and volunteers are to be named as an additional insured for both
general liability and automobile liability by means of an additional insured endorsement (e.g., must have an additional insured
endorsement/ certificate naming the "City of Mountain View" provided by your insurer).
Worker's Compensation
Signature: ________________________________________________________ Date: ________________________________
I have reviewed FAQs and submitted all required forms as requested:
2
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City of Mountain View
Insurance and Locations Pages
City Manager's Office | 500 Castro St., Mountain View, CA 94040
city.mgr@mountainview.gov | (650) 903-6301 | Fax: (650) 962-0384
Interior
Start Time End Time
Exterior
Both
Interior
Start Time End Time
Exterior
Both
Interior
Start Time End Time
Exterior
Both
Indicate street address or cross streets.
Please list locations by date and time. Note all locations used.
(Office Use Only) Neighborhood Notification Police Services Fire Services
F Street Closure*(*Denotes additional permitting, fees and/or plan submittals required )
Conditions: Temporary Use Permit Traffic Control Plan Staging Area
#
Location: ______________________________________________________________
Date and Day of the Week
Scene Summary
# of Cast & Crew on Location:
Parking Request (Include Map)*
Generator (type and size): ___________________ (No Gas Generators Allowed)
Ext. Dolly / Jib Pyrotechnics*
List other specialized equipment:
Intermittent Traffic Control (Include Map)* Simulated Violence
List other specialized equipment:
Intermittent Traffic Control (Include Map)* Simulated Violence
F Street Closure*(*Denotes additional permitting, fees and/or plan submittals required )
(Office Use Only) Neighborhood Notification Police Services Fire Services
Conditions: Temporary Use Permit Traffic Control Plan Staging Area
(8) Location Information
#
Location: ______________________________________________________________
Date and Day of the Week
Scene Summary
# of Cast & Crew on Location:
Generator (type and size): ___________________ (No Gas Generators Allowed)
Parking Request (Include Map)*
Ext. Dolly / Jib Pyrotechnics*
List other specialized equipment:
Intermittent Traffic Control (Include Map)* Simulated Violence
# of Cast & Crew on Location:
Generator (type and size): ___________________ (No Gas Generators Allowed)
Parking Request (Include Map)*
Ext. Dolly / Jib Pyrotechnics*
F Street Closure*(*Denotes additional permitting, fees and/or plan submittals required )
(Office Use Only) Neighborhood Notification Police Services Fire Services
Conditions: Temporary Use Permit Traffic Control Plan Staging Area
#
Location: ______________________________________________________________
Date and Day of the Week
Scene Summary
3
Finance and Administrative Services Department • Risk Management Division
500 Castro Street • Post Office Box 7540 • Mountain View, California 94039-7540 • 650-903-6060 • FAX 650-968-5472
VOLUNTARY ASSUMPTION OF RISK, RELEASE OF LIABILITY AND
INDEMNIFICATION AGREEMENT
I, ____________________________________________________________, have made a request to be permitted on the
City of Mountain View's property at _______________________________________________________________ for the
period of ________________________________________ to conduct a specific work/educational project.
The City of Mountain View is willing to allow me onto City property if I agree to the following conditions:
I hereby waive, release and discharge any and all claims for death, personal injury or property damage against the
City of Mountain View, its officers, officials, employees and volunteers that I may sustain or may accrue as a
result of my presence on and travel to and from City property. I understand and agree that this waiver and
release includes claims or damages caused in whole or in part by the negligent acts or omissions of the City, its
officers, officials, employees and volunteers.
In addition, I agree to indemnify, defend and hold harmless the City, its officers, officials, employees and volun-
teers from any and all liabilities for claims, loss, demands, injury or damages or actions that arise out of or relate to
my participation of the work/educational project on my own behalf or on behalf of a client.
I also agree that in the event of a loss due to my operation and completion of the project I shall look solely to my
own insurance coverage for recovery. My insurance coverage is primary and noncontributory. I agree to a waiver
of any right to subrogation which any such insurer I may have contracted with against the City by virtue of the
payment of any loss under such insurance.
If you are going to use a photo/video of a person in which the face is clearly recognizable, you will obtain a photo
release signed by the individual or by the guardian if the person is under 18 years of age. It is your sole responsi-
bility to obtain and retain the release documentation.
I have carefully read this release form and I fully understand the terms used in it and their legal significance. I
understand that this release is a legally binding contract between the City and me. I am not a minor and I am fully
competent to enter this release. No oral representations or inducements have been made to me to sign this
release. I understand that while working on this project I am not an agent of the City.
THIS IS A RELEASE OF YOUR RIGHTS, READ CAREFULLY BEFORE SIGNING
Signature Date
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
Name and Address (print) Phone Number
CK/9/FIN
570-05-15-07A^
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City Of Mountain View Photography and Film Permitting (City of Mountain View)

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Completed 14 July 2020

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