Film and Photo Application

Film and Photo Application
Contact Information

City of Prescott

201 S. Cortez St.

Prescott, AZ 86303

928-777-1460

sam.rice@prescott-az.gov
Production Title:*
Production Description (i.e., catalog, TV, etc.):*
Company:*
Office Phone Number:*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Location Manager:*

First NameLast Name
Location Manager Cell:*
Please enter a valid phone number.
Location Manager Email:*
example@example.com
Asst. Location Manager:

First NameLast Name
Asst. Location Manager Cell:
Please enter a valid phone number.
Asst. Location Manager Email:
example@example.com
Director/Photographer:*

First NameLast Name
Production Manager:*

First NameLast Name
Total Project Budget:*
Total Prescott Spend:*
Person on Location Responsible for Company's Adherence to Terms and Conditions of Permit:
Name:*

First NameLast Name
Title:*
Cell:*
Please enter a valid phone number.
Email:*
example@example.com
PERMIT APPLICATION FEE SCHEDULE (Please check one):*

Still/Photo Shoot - $50.00Television/Internet/Gaming - $100.00Movie/Feature - $200.00
Payment:

Once application is approved, the Film Commissioner will reach out with payment options.

Location Fees/Deposits:

Additional fees/deposits may apply for locations and services required for production. Pleae contact the Film Commissioner for details.

Certificate of Insurance

A certificate of insurance shall accompany application and payment and MUST include Endorsement 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:

1003420-6435

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.?*

YesNo
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:*
Attachment:

Cancelof
Describe Equipment on Location:*
Using a UAS/UAV?*

YesNo
If yes, please provide aircraft registration, remote pilot certificate and markings:
UAS/UAV Attachments:

Cancelof
Describe Filming Activity/Scenes at Location (attach script and/or story board):*
Script and/or Story Board Attachments:*

Cancelof
Describe Driving Scenes and Attach Map of Route:*
Map of Route Attachment:

Cancelof
Describe Use of Vehicles, Boats, RV's, Aircraft, Pyrotechnics, Special Effects, Animals or Other Props: *
Describe All On-Site Construction:*
Do you need to add another location?*

YesNo
If you need additional locations, please print off this form and complete it for each location and attach them here:

Cancelof

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 the 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 on today's date of, Date* .
Signature of Authorized Signer:*

Clear
Printed Name:*

First NameLast Name
Title:*
Company:*
Should be Empty:

Film and Photo Application

Person on Location Responsible for Company's Adherence to Terms and Conditions of Permit:

Location Information

Conditions: