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2. Applicant Information
4. Applicant (Company) Name:
6. This Company Is A:

   1. Sole Proprietor
   2. Partnership
   3. Limited Partnership

   1. Corporation
   2. LLC

   1. 501(c)(3) Non-profit
   2. Other
8. If Other, Please Specify:
10. Applicant Contact Name
12. Applicant Address
14. Office Phone
15. Cell Phone
17. Fax
18. Email Address
22. Property Owner Information
24. Property Owner Name
26. Property Owner Address
28. Office Phone
29. Cell Phone
31. Fax
32. Email Address
36. First Day of Filming
38. This Application Has Been Submitted on

    (Please Enter Today's Date - Month, Day, Year)

40. Which Is __ Business Days Before the Filming Operation Begins.

    (Please enter the number of business days between today and the start of the filming operation. Please note, applications must have AT LEAST 10 business days between submission and start date.)

42. The Filming Operation is Scheduled to Begin on

    (Please enter the date you will start the filming operation - Month, Day, Year)

46. Commercial Filming or Photographic Description
48. The proposed commercial filming or photographic operations will be completed:

    1. Within 4 weeks

    1. More than 4 weeks
50. Number of people associated with the filming or photographic activities:
52. Provide a narrative the activities to take place:
54. Proposed date and time of operation(s) per location:
56. Provide a location map indicating the area of filming or photographic activities.
58. The proposed commercial filming or photographic operations will include and/or need:

    1. Use of outdoor City facilities (streets, park, etc)
    2. Use of indoor public facilities (City Hall, Police Department, Municipal Court)
    3. Access to electricity and/or water
    4. Closure of city facilities
    5. Road closure/traffic disruption
    6. Aerial filming
    7. Pyrotechnics, gunfire, blank fire

    1. Amplified sound, bullhorns, sirens
    2. Wild animals
    3. Public nudity
    4. Access to dumpsters (trash is the responsibility of the applicant)
    5. Use of extreme obscenity (would require R or greater rating)
    6. Other
60. If Other, Please Specify:
62. Describe how the filming or photographic activities will impact the public at each location, including but not limited to, the anticipated impact on local businesses, charitable or religious organizations, vehicle and pedestrian traffic:
64. Describe the vehicles and equipment involved at each location:
66. Describe the need for any barricades or other obstructions to pedestrian or vehicle traffic may will be required at each location, and, if so, a plan showing the location and a description of such barricades or obstructions:
68. Describe all special effects, including stunts and pyrotechnics to be used at each location, including but not limited to simulated explosions, fires, gunfire, vehicle chase scenes and stunts:
70. Describe the emergency medical personnel or fire suppression equipment for the employees and the public in each such location where special effects such as stunts, pyrotechnics, simulated explosions, fires, gunfire, vehicle chase scenes and stunt:
72. Submit a copy of a safety plan to protect the health, safety and welfare of the employees and the public in each such location:
74. (Additional Comments Regarding Safety Plan)
76. Submit copies of any licenses or permits issued by the State or Federal Government for the possession and use of pyrotechnics, explosive devices or restricted weapons to be used during the filming or photographic activities, by the applicant, its employees, subcontractors, agents and suppliers:
78. Describe the anticipated decibel level and duration of noise at each location:
80. Provide a pedestrian or vehicular traffic control plan for areas impacted by the associated with the filming or photographic activities:
82. Public notification shall be provided by door to door notification of all affect residential, commercial and semi-public areas and by any of the following selected methods:

    1. Mobile Illuminated Signs
    2. Leaflets

    1. Mailed Notice
    2. Temporary Signage

    1. Other
84. If Other, Please Specify:
86. Please Attach a Copy of the Public Notice

    The public notice shall include the following information:

    • The number of people involved in the activity,
    • A description of the activities to take place,
    • A schedule of the activities to take place, AND
    • A description of the area where the activities will take place
90. Legal
92. Please Print, Sign, and Upload the Attached Acknowledgement Form

    Filming Acknowledgment Form

96. Insurance
98. Applicant shall submit a bond, insurance or both an amount not less than five hundred thousand dollars ($500,000.00), to protect the city against claims of third persons for personal injury, wrongful death and property damage and to indemnify the city for damage to city property arising out of the applicant's activities.
100. The applicant has submitted a

     1. Bond

     1. Insurance
102. In the Amount of:

     (Please Enter Dollar Value)

104. A minimum of five million dollars ($5,000,000.00) of such bond, general liability insurance coverage or both shall be required in the event aircraft, helicopters, pyrotechnics or automobile chase scenes are used in the activity. Such insurance shall be evidenced by the standard general liability special endorsement form mandated by this chapter. City shall be listed as additional insured and applicant shall have primary coverage.
106. Or if Not Applicable:

     1. N/A
108. The applicant shall execute an indemnity and hold harmless agreement as provided by the city prior to the issuance of any permit that shall hold the city harmless against any claims, liability or judgments arising out of the applicant's activities.
110. Please Print, Sign and Upload the Attached Indemnification and Hold Harmless Agreement

     Indemnification and Hold Harmless Agreement

Leave This Blank:


112. 1. Receive an email copy of this form.
113. Email address

     This field is not part of the form submission.

114. Submit

* indicates a required field