Fillable Fseprd535890 Film and Photo Request Form: Columbia River Gorge National Scenic Area

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Fseprd535890 Film and Photo Request Form: Columbia River Gorge National Scenic Area

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The Fseprd535890 Film and Photo Request Form: Columbia River Gorge National Scenic Area form is 2 pages long and contains:

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File type: PDF

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Forest Service Use Only:
Date Received
Permit #
PHOTOGRAPHY
& FILMING REQUEST
Columbia River Gorge National Scenic Area
Supplement to the SF 299 Application
Requests must be received at least 10 business days prior to shooting. No Exceptions.
Proposals that involve high impact use and environmental analysis may require longer processing times.
Red outlined fields are required. The request will be returned if information is missing or incomplete.
Date:
C
ompany:
Authorized
Representative:
Address:
Phone:
Fax:
Tax ID:
Project Title:
Production Date(s)
(and alternate dates):
Primary Contact
and Title:
Phone:
Backup Contact
and Title:
Phone:
I. PRODUCTION INFORMATION:
PRODUCTION TYPE:
Still Photography Commercial TV Movie TV Episodic Feature Film
Music Video Corporate Video Documentary Other
PROPONENT TYPE: LLC Non-profit (501.c.3) Commercial Corporation Person/Individual
Other Organization
PROPOSED LOCATION(S) (Include size of area to be used and legal description):
NOTE: The Columbia River Gorge National Scenic Area ownership is very segmented. It is the responsibility of the
proponent to determine if coordination with other agencies or private landowners is necessary.
Total number of people on location:
(include actors, crew members, etc.):
Set up (date, length of time, time of day):
Production (start/stop):
Breakdown and restoration (start/stop):
STUNTS/SPECIAL EFFECTS PROPOSED:
Pyro
technics Hazardous Materials Riparian Area; within 200’ of surface water Aerial Stunts
Domestic/Wild Animals Developed Recreation Site Using off-site plant materials (wreaths, flowers, trees)
Other
SPECIAL REQUEST INFORMATION:
Drone/UAS
Other Aircraft
Wilderness
Other
Choose from below
ll. DESCRIPTION OF ACTIVITY:
Include the following: proposed use including all activities, ground disturbing work, and actions that block
pedestrian or vehicle traffic; attach narratives and story boards of action with full descriptions.
Map of area/set up attached (required):
Yes
No
Where will vehicles be parking?
Where will supporting facilities (dressing rooms, catering, portable restrooms, props, etc.) be located?
lll. DESCRIPTION OF EQUIPMENT:
EQUIPMENT DETAIL (number of):
Generators Cars Trucks RVs Other
Action involving vehicles and/or equipment:
Props proposed:
Traffic and safety control/
special closures measures needed:
Have you obtained permission to use improvements not owned by/under the jurisdiction of the United States
Government, i.e. structures, roadways, etc.?
Yes
No
Applicants Signature: ________________________________ Date: _______________
Forest Service Use Only:
Fees
Photography/Filming Land Use Fee:___________________
Permit Preparation/Monitoring Cost:___________________
(See attached financial plan)
Total Amount: ____________________
Certification of Insurance Received: Yes No
Bonding:
Required: Yes No Amount:_____________
Received: Yes No
Concessionaire/Permittee Coordination Required:
Yes No
Other Landowner/Agency Coordination Required:
Yes No
2020 Land Use Fee Schedule
Minimum Use Fee $115
Still Photography
1-3 people $115/day
4-15 people $247/day
16 or more $411day
Motion Picture & TV production
1 -3 people $115/day
4 -10 people $251/day
11-30 people $328/day
31-60 people $823/day
61 or more $988/day
Fees are subject to change, contact local permit
administrator to confirm fees.
In addition to the above use fee, a minimum
$128 will be charged for permit
processing. Additional fees may be added
depending on permit complexity and
monitoring needs.
Certificate of Insurance Required
See attached insurance requirements.
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USDA Forest Service Insurance Requirements
The following insurance guidelines are provided to show why insurance requirements
are necessary and how the Certificate of Insurance needs to be prepared to meet the
agency direction
The Special Use Permit requires the Permittee to indemnify the United States against
any liability for damage to life or property arising from the occupancy or use of National
Forest System Lands. The Permit requires the Permittee to have the insurance
company name the United States Government (Forest Service) as an additionally
insured party. Also, the Certificate of Insurance and the insurance policy shall contain
a specific provision to the effect that the policy shall not be cancelled or the provisions
changed or deleted before thirty (30) days written notification by the insurance
company to the U.S. Government, c/o USDA Forest Service.
A Certificate of Insurance must be presented to the Forest Service before a Special
Use Permit will be issued. For long-term or high risk projects the Authorized Officer
may require that a copy of the actual insurance policy be furnished before the permit is
issued.
The following acceptable additional insured clause shall be shown in verbatim on the
face of the Certificate of Insurance or Binder and, as a clause or an endorsement in the
insurance policy:
'It is understood and agreed that the United States Government is additional
insured solely as respects liability arising from operations of the named
insured."
In addition, the following 30 day clause is also mandatory and shall be shown in
verbatim on the Certificate of Insurance as well as in the insurance policy:
"It is understood and agreed that the coverage under this policy will not be
changed or its provisions changed or deleted before thirty (30) days written
notice to the:
United States Government, USDA Forest Service,
Columbia River Gorge National Scenic Area
902 Wasco, Suite 200
Hood River, OR 97031
United States Government, c/o USDA Forest Service, Columbia River Gorge
National Scenic Area shall be listed in the certificate holder box.
If these clauses are not on the Certificate of Insurance in verbatim, and are not in the
insurance policy or on an endorsement as stated above, a Special Use Permit will not
be issued.
The amount of insurance required will depend on the degree of risk involved. The
Forest Representative administering the special use permit will inform the prospective
permittee of the required liability coverage necessary, such as: (coverage’s shown
minimums)
(1) $ 10,000 Property Damage
(2) $100,000 Death or injury to One Individual, and
(3) $300,000 Death or injury to more than One Individual
(4) $300,000 Combined Single Limit (CSL)
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Fseprd535890 Film and Photo Request Form: Columbia River Gorge National Scenic Area

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Completed 10 May 2020

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