City of White Plains Filming
Application Form
(keep a copy of this permit on location at all times)
For questions or comments send e-mail to: jiannetta@whiteplainsny.gov
Production Company:
Production Title:
Production Type Feature TV Series/ Pilot Movie
Commercial Student Film Still Photography
Tents
Other
Company Information:
Company Name:
Address:
City/ State / Zip:
Phone: E-mail Address:
Location Manager: Cell Phone:
Alternate Contact/Title Cell Phone:
Insurance Carrier Policy #: Exp. Date:
Location Address, Dates and Times:
1.
2.
3.
4.
Alternative Film Date
Equipment and
Personnel:
Camera car Picture car Generator Crane
Lights
Number of Personnel (include all cast, crew, extras and clients)
Trucks # Motorhomes # Honey wagon #
Vans # Parking
(#cars)
Extras parking (#cars)
Other Equipment (please list):
Banners: Yes No
If yes, describe:
Describe scene to be filmed:
Special Effects: Pyrotechnics Stunts
Firearms Loud Noises
If yes, describe:
Street Closure Required
Yes
No
Lane Closure Required
Yes
No
Parking Restrictions
Yes
No
Is there talent involved?
Yes
No
Camera in curb lane: Yes
No
Driving Shots: Yes
No
POLICE USE ONLY
PUBLIC SAFETY REQUIREMENTS/RESTRICTIONS
Traffic:
Street Closure
Approved:
Yes
No
Lane Closure
Approved:
Yes
No
Intermittent Traffic
Control (ITC)
Approved:
Yes
No
Parking Restrictions: Yes
No
If yes, indicate
location and time:
If any part of your production includes loud noises, applicant must notify in writing all
residents and businesses within 500 feet within 7 working days prior to filming. (initial)
Refund/ Invoice to:
Attention:
Company Name:
Address:
Film Permit Provisions
Permittee waives all claims against the City of White Plains, its officers, agents and employees, for loss or
damage caused by, arising out of, or in any way connected with the exercise of this permit. Permittee herby
agrees to indemnify, defend and hold the City, its authorized agents, officers, representatives and employees
harmless from and against any and all losses, damages or claims, causes of action, costs, liabilities, penalties,
judgements and expenses, including, without limitation, defense costs and reasonable legal fees, resulting from
any and all claims or damage of any nature, including any accident, loss or damage to persons or property which
the City may incur and which arise from or relate to any activity conducted by permittee or any of its officers,
agents, employees, representatives, contractors, consultants, or students in connection with the rights granted in
the permit or under White Plains Municipal Code Chapter 4-26.
City shall have the privilege of inspecting the premises covered by this permit at any or all times.
City may terminate this permit at any time if Permittee fails to perform any covenant herein contained at the time
and in the manner herein provided. City agrees it will not unreasonably exercise this right of termination.
The parties hereto agree that the Permittee, its officers, agents and employees, in the performance of this permit,
shall act in an independent capacity and not as officers, employees or agents of the City.
No alteration or validation of the terms of this permit shall be valid unless made in writing and signed by the parties
hereto.
Permittee shall not discriminate against any employee or applicant for employment because of race, color,
religion, ancestry, sex, age, national origin or physical handicap.
Id Permittee is unable to film on schedule date due to inclement weather, City must be notified in writing by next
business day in order to reassign permit fees to a rescheduled date.
City shall be compensated for any loss or damage to City property by Permittee.
Permittee agrees to clean and restore the property to its original condition prior to use as a location site.
Public Use of City Park Facilities - - No vehicle(s) allowed on park turf areas. All film equipment must be
transported via dolly or hand carried in and out of park facility. No temporary parking of vehicle(s) on park turf for
loading or unloading of equipment.
Permittee is responsible for fully complying with posted signage surrounding the requested film site. The City of
White Plains will not dismiss any citation issued to the Permittee or any person(s) associated with the film
production who are in violation of posted regulations.
Permittee hereby agrees to comply with all the rules and regulations of the facility or institution subject to this
permit.
Permittee hereby agrees to ensure compliance with the conditions of the permit, agrees to obtain prior City
approval for deviations from the information provided herein and understands that failure to comply with these
requirements may result in the immediate cancellation of filming. [NOTE: Facilities Supervisor approval required
for use of City park facilities only.]
Applicant: Date:
Approved: Date:
The undersigned acknowledges that the City of White Plains shall not be liable at any time, and the
undersigned agrees to assume all risks for any loss, damage or injuries whatsoever to the person or
property of any person or entity whatsoever arising out of the above-referenced processes, materials or
conditions which are implemented as part of the above-referenced film production.
Applicant's Signature:
Name:
APPROVAL
COMMISSIONER OF DEPARTMENT OR HIS DESIGNEE FOR:
DPW:
PUBLIC SAFETY:
PARKING/TRAFFIC:
BUILDING
DEPARTMENT:
MAYOR'S OFFICE:
Approved subject to the following conditions:
Approved without conditions:
Dated: By:
Name: Title:
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