Fillable Film and Photo Application PRESCOTT AZ FILM OFFICE (City of Prescott)

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Film and Photo Application PRESCOTT AZ FILM OFFICE (City of Prescott)

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The Film and Photo Application PRESCOTT AZ FILM OFFICE (City of Prescott) form is 4 pages long and contains:

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  • 3 check-boxes
  • 72 other fields

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U.S.A. forms for City of Prescott

BROWSE CITY OF PRESCOTT (AZ) FORMS

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PRESCOTT AZ FILM OFFICE
City of Prescott
201 S. Cortez St.
Prescott, AZ 86303
(928) 777-1204
FAX (928) 777-1255
Film and Photo Application
Production Title:
Project Description (i.e., catalog, TV, etc.):
Company: Office Phone No.:
Address: City, State, ZIP:
Location Mgr: Cell: Email:
Asst Location Mgr: Cell: Email:
Director/Photographer: Production Mgr:
Total Project Budget: Total Prescott Spend:
Person on Location Responsible for Company’s Adherence to Terms and Conditions of Permit:
Name: Title: Cell:
PERMIT APPLICATION FEE SCHEDULE (Please check one):
Still/Photo Shoot .................................................................................$50.00
Television/Internet/Gaming ...............................................................$100.00
Movie/Feature ...................................................................................$200.00
Please make checks for permitting payable to the “City of Prescott” or enter credit card information
below and send to the attention of the Film Commissioner at address listed above.
Name on Credit Card (please print):
Credit Card No.: Exp. Date:
Card Type (Circle One): Visa/MasterCard/American Express CCV Code:
Authorized Signature:
LOCATION FEES/DEPOSITS: Additional fees/deposits may apply for locations and services required
for production. Please contact the Film Commissioner for details.
CERTIFICATE OF INSURANCE: A certificate of insurance shall accompany application and payment
and MUST include Endorsements page/s. Certificates shall be not less than $1 million and list the “City
of Prescott” as an additional insured. Some locations and services may require additional insurance.
Please contact the Film Commissioner for details.
For City Use Only:
1009999-6435
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signature
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LOCATION INFORMATION
Complete this section for EACH location
Location Address:
Filming Date/s:
Number of Days:
Time/s:
Are you requesting times before 7:00 a.m. or after 7:00 p.m.? Circle one: YES / NO
If yes, please explain your request:
Total No. of Crew & Cast on Location:
List Name of Celebrities, Products and Sponsors:
Total No. and Type of Vehicles on Location:
Attach or Describe Traffic/Parking Plan:
Describe Equipment on Location:
Using a UAS/UAV? Yes _____ No _____ If yes, please provide aircraft registration and markings.
Describe Filming Activity/Scenes at Location (attach script and/or story board):
Describe Driving Scenes and Attach Map of Route:
Describe Use of Vehicles, Boats, RV’s, Aircraft, Pyrotechnics, Special Effects, Animals or Other Props:
Describe All On-Site Construction:
Did you:
 Complete all highlighted sections?
 Attach Certificate of Insurance and Endorsement Page/s? (required for all
projects).
 Include Payment?
CONDITIONS:
1. Compliance with Law. Permittee shall obey all City Ordinances, FAA regulations and guidelines, rules and the guidance
of City supervisory employees pertaining to the use of City property, including the location and storage of vehicles and
equipment, crowd control, and the restoration of premises to their original condition after use for filming purposes.
2. Location Approval. Permittee shall confine its activities to the locations and time schedules approved by the
Film Commissioner’s Office and shall make arrangements through that office for traffic control satisfactory to the
Police Department prior to filming on City streets and in other public areas.
3. Commercial Use of City Logo. Use of the City of Prescott logo is prohibited unless written approval is granted
by the City Manager.
4. Indemnity. Permittee does hereby covenant and agree to indemnify and hold harmless the City from any and all
loss, cost, damages, and expenses of any kind, including attorney’s fees, on account of personal injury or property
damage resulting from any activity of Permittee on municipal property or in connection with the use of municipal
property.
5. Liability Insurance. In no way limiting the indemnity agreement above, Permittee will furnish City with a
Certificate of Liability Insurance acceptable to its legal Department showing combined single limit coverage for
bodily injury and property damage, or the equivalent of such coverage, not less than $1 million. The City, including
its officials, employees, and agents, shall be named an additional insured in the Liability Policy. Contractual liability
coverage insuring the obligations of this agreement also is required. The insurance may not be canceled or
substantially modified without 10 days written notice to the City Clerk.
6. Security for Costs. Permittee shall reimburse the City for costs incurred in the use of City equipment and
assignment of city employees to duty in connection with filming activities. A schedule of expected costs shall be
prepared by the Film Commissioner’s Office after identification of the municipal sites to be used for filming.
Permittee shall post a cash bond as a refundable deposit against such estimated costs when requested to do so.
7. Relationship of Parties. Neither permittee, or its agents, employees, servants, or helpers, shall be or deemed to
be, the employee, agent, or servant of the city. None of the benefits provided by the City to its employees, including,
but not limited to medical insurance, compensation insurance, and unemployment insurance, are available to
permittee, or its employees, agents, servants, or helpers.
8. Special Events. Except as provided in Paragraphs 6 and 9, no fees shall be charged by Permittee for use of city
property. Permittee shall not conduct any event on city property intended to attract or entertain the public or charge
fees to spectators without the express written approval of the Film Commissioner.
9. Limitations. Additional permits are required for use of revenue producing facilities of the City and entry upon
areas subject to special security requirements, such as the municipal airport. Use of such facilities and areas may be
further conditioned upon provision of additional insurance coverages, written assurances of compliance with
security requirements and other requirements.
10. Appointment of Agent. Permittee shall designate a local agent to sign this license who shall have the authority
to represent permittee in all matters relating to exercise of the privileges herein granted and who shall be responsible
for compliance with these conditions.
11. Off-Duty City Personnel When permittee finds it necessary to hire full-time OFF-DUTY City employees to
work under this permit, all such employees shall be hired for a minimum time period of four (4) hours a day. When
off-duty city employees are authorized to provide, or are providing, City equipment, their work hours shall include
time spent going from the pick-up location of the equipment to the production site and the return trip. It is expressly
understood that all off-duty City employees working for the permittee are, during such work periods, employees of
the permittee and NOT of the City of Prescott.
AGREED to this ____________day of __________________, 20_______.
Permittee:
Signature of Authorized Signer Title
Printed Name
Permit No:
A revocable license is granted to:
Company Company Address
Representative Phone
Insurance Carrier Insurance Carrier Address
for the use of property within the city limits, as herein described in connection with the filming,
taping or photographing of a production known as
Use of city facilities as a location site must be cleared through the Film Commissioner’s Office
prior to filming. Locations, including city-owned locations, to be used are:
Conditions/Restrictions:
This license is issued based on the above production description and is subject to the conditions
herein and attached. The permit may be extended upon request and receipt of the Film
Commissioner’s Office approval. The permit may be revoked by the Film Commissioner or an
authorized representative in the event of noncompliance or misrepresentation.
The permit is valid for the following date/s and time:
DATED this ____________day of __________________, 20_______.
Permittee:
Signature of Authorized Signer Title
Printed Name
APPROVED this ____________day of __________________, 20_______.
WENDY BRIDGES
Film Commissioner, City of Prescott
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Film and Photo Application PRESCOTT AZ FILM OFFICE (City of Prescott)

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Completed 24 February 2021

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