Fillable Form 1.: PERMIT FOR FILMING WITHIN THE HAINES (Haines Borough)

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Form 1.: PERMIT FOR FILMING WITHIN THE HAINES (Haines Borough)

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The Form 1.: PERMIT FOR FILMING WITHIN THE HAINES (Haines Borough) form is 4 pages long and contains:

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  • 7 check-boxes
  • 35 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Haines Borough

BROWSE HAINES BOROUGH (AK) FORMS

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1
PERMIT FOR FILMING
WITHIN THE HAINES BOROUGH
This Filming Permit Agreement (“Agreement”) is between ,
a (“Permittee”) and the Haines Borough (the “Borough”) with regard to an event
Permittee
desires to hold on property owned by the Haines Borough (“Borough Property”). The Parties
agree to
the following terms:
1.
Identity of Parties: All communications concerning this contract shall be directed as
follows, any reliance on a communications with a person other than that listed below is at
the party’s own risk.
Haines Borough
Permittee:
Attn: Borough Manager
Attn:
P.O. Box 1209
Haines, AK 99827
Phone: (907) 766-2231
Phone:
Fax: (907) 766-2716 Fax:
This Agreement extends to not only the parties as set forth above, but also to the parties’
owners, affiliates, officers, directors, partners, agents, employees, landlords, lessees,
sublessees, predecessors, assigns, shareholders, representatives, and subrogees.
2.
Scope: The scope of this permit is limited to:
Production Name:
Specific Location
Date (MM/DD/YY)
Time(s)
on location
2
PERMIT FOR FILMING
WITHIN THE HAINES BOROUGH
2. Scope: cont’d
Specific Location
Description of Activity
(include requests for exclusive use)
Additional sites requested, dates, times, number of people on location, description of
activity, and/ or general comments (may attach additional page if needed):
3
PERMIT FOR FILMING
WITHIN THE HAINES BOROUGH
3.
Insurance: Insurance coverage as described in Attachment A is required for this permit.
Prior to
issuance of a permit, the Permittee must submit a certificate of insurance showing the
Permittee has
obtained the necessary insurance in the types and amounts listed in the permit
conditions. The
Borough reserves the right to modify insurance requirements, if appropriate, depending on the nature
of the project.
4.
Indemnification: The Permittee agrees to defend, indemnify, and hold harmless the Borough, its
employees, volunteers, consultants, and insurers, with respect to any action, claim, or lawsuit
arising out of or related to the Permittee’s performance of this permit, without limitation as to the
amount of fees, and without limitation as to any damages, cost or expense resulting from
settlement, judgment, or verdict, and includes the award of any attorneys’ fees even if in excess of
Alaska Civil Rule 82. This indemnification agreement applies to the fullest extent permitted by law
and is in full force and effect whenever and wherever any action, claim, or lawsuit is initiated, filed,
or otherwise brought against the Borough relating to this permit. The obligations of Permittee arise
immediately upon actual or constructive notice of any action, claim, or lawsuit. The Borough shall
notify Permittee in a timely manner of the need for indemnification, but such notice is not a
condition precedent to Permittee’s obligations and is waived where the Permittee has actual notice.
5.
Assumption of Risk: Permittee assumes all risk and is solely responsible for conducting all
activities in a safe and diligent manner and not to pose a danger to other users of the Borough
Property.
6.
Damages: The Permittee shall pay the Haines Borough for any damage caused to Borough property
associated with the Permittee’s use of Borough property.
7.
Not Exclusive: Unless otherwise stated, this permit does not give the Permittee an exclusive right
to use the Haines Borough property. Fees may be assessed for special purposes and/or Borough
staff support.
8.
Compliance: The Permittee shall comply with all applicable laws and regulations.
9.
Assignment: This permit may not be transferred or assigned without the written
consent of the Borough Manager, or designee.
10.
Revocation: This permit may be terminated upon breach of any of the conditions herein or in the
best interest of the Haines Borough as determined by the Borough Manager.
Borough Lands and Resources Staff Only: Conditions and Comments
4
PERMIT FOR FILMING
WITHIN THE HAINES BOROUGH
11.
Leave No Trace: The Permittee shall ensure that its activities are conducted in a
manner such that the property will be returned to its original condition upon
termination of the Permittee’s activities. Any materials or supplies brought in by the
Permittee must be removed upon termination of Permittee’s activities or upon
termination of this authorization.
12.
Jurisdiction and Venue: The Superior Court for the State of Alaska, First Judicial
District at Juneau, Alaska shall be the exclusive jurisdiction for any action of any
kind and any nature arising out of or related to this Agreement. Venue for trial in
any action shall be in Juneau, Alaska. The laws of the State of Alaska shall govern
the rights and obligations of the parties. Permittee specifically waives any right or
opportunity to request a change of venue for trial pursuant to AS 22.10.040.
13.
Counterparts: This Agreement may be executed in counterparts, each of which
constitutes one and the same agreement.
14.
Effective Date: This Agreement is not effective until signed by the Haines Borough.
The parties agree by signing below that this is a valid agreement.
Dated:
Permittee
(Print Name)
Dated:
Haines Borough
BY:
(Print Name)
BY:
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ATTACHMENT A – INSURANCE REQUIREMENTS
INSURANCE REQUIREMENTS - Proof of insurance is required before the
issuance of
the Permit.
The Permittee shall provide evidence of coverage in the form of a certificate of insurance
with a carrier or carriers satisfactory to Haines Borough covering injury to persons and/or property
suffered by the Borough or a third party, as a result of operations under this permit by the Permittee
or by any subcontractor. This coverage will also provide protection against injuries to all employees
of the Permittee. Insurance carriers providing coverage shall have an “A.M. Best rating” of at least
an “A-VII”. During the performance of work under this contract, the Permittee shall maintain the
approved insurance in force at all times. The Permittee shall provide, as a minimum, the following
insurance:
Commercial General Liability Insurance: Such insurance shall cover all operations by, or on
behalf of, the Permittee providing insurance for bodily injury and property damage liability
including coverage for premises and operations, products and completed operations, contractual
liability, broad form property damage, and personal injury liability. Coverage shall be written on an
occurrence based form. The minimum limits of liability shall be:
•
$1,000,000 each occurrence for General Liability and Products/Completed Operations
•
$1,000,000 for Personal Injury/Advertising Liability
•
$2,000,000 Aggregate for Products/Completed Operations
•
$2,000,000 General Aggregate
Business Automobile Insurance: $1,000,000 per accident combined single
limit
covering owned, non- owned and hired automobiles.
The Haines Borough shall be named as an Additional Insured under
all liability coverage’s
listed above. The certificate must state, “The Haines Borough shall be named
as Additional
Insured with respect to any and all work performed for the Borough.”
Workers’ Compensation Insurance: Permittee, if subject to the provisions of the Alaska
Workers’ Compensation Act (AS 23.30), will provide with this application proof, furnished by the
insurance carrier, of current coverage for workers’ compensation with an insurance company or
association authorized to transact such business in the State of Alaska, or an approved current
certification of self-insurance by the Alaska Workers’ Compensation Board. Permittee further
acknowledges and agrees that in the event it fails to maintain proper workers’ compensation
coverage, the State will implement the provisions of AS 23.30.045(c), at its option, may terminate
this permit for cause without liability.
The coverage shall include Employer’s Liability Protection in the amount of:
•
$100,000 per accident,
•
$500,000 policy limit, and
•
$100,000 each employee.
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Form 1.: PERMIT FOR FILMING WITHIN THE HAINES (Haines Borough)

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Completed 17 July 2020

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