Complete form and submit online or print and fax to 561

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Complete form and submit online or print and fax to 561.233.3113.

The Palm Beach County Film & Television Commission
Application/Permit For Use of County/Municipal Taxing District Property

Palm Beach County Film & Television Commission
1555 Palm Beach Lakes Blvd #900
West Palm Beach, FL 33401
PHONE: 561.233.1000 or 800.745.FILM or FAX: 561.233.3113

The APPLICANT agrees to have a representative on site at all times with authority over filming director, crews and all other aspects of their operation and empowered to act for the APPLICANT

APPLICANT: Representative/Title:

Address:

City: State: Zip Code: Telephone:

FAX: Mobile#: E-mail Address:

Project/Title:
Local Address/Hotel: Phone:
Number of Room Nights (out of town crew/talent multiplied by nights stayed):

Type:

1. Feature Film:		3. M.O.W:		5. TV Series/Pilot		7. Film		9. Infomercial		11. Music Video
2. Commercial		4. Stills		6. Documentary		8. Video		10. Other		12. Student Project

Dates of Filming: Times:
Insurance On File/ Attached? Yes No

Locations in Palm Beach County (Each MUNICIPALITY, COUNTY, or TAXING DISTRICT owned location must be identified separately)

Nature of the Shoot:

Identify any special MUNICIPALITY, COUNTY, or TAXING DISTRICT assistance required:

Traffic Control		Street Closing		Shots of Police/Fire/Rescue Equipment
Parking		# of Parking Spaces Required		Other (explain):

Explain:

If a shoot is cancelled, it is the sole responsibility of the Production Company to notify hired law enforcement. The Production Company will assume responsibility for compensation should the Production Company fail to deliver proper notification.

Identify all Unusual Activities:

Stunts	Animals	Explosives/Fireworks
Fire Arms	Fires	Airplanes/Helicopters
Vehicles	Watercraft	Other (explain)

Explain:

The FTC shall require script approval for all scenes shot on Palm Beach County School Property. Additionally, films must not use the School name, use students, or contain scenes depicting alcohol, tobacco and drug use, nudity, or violence. Production Company shall contact Film Commission, not municipality staff, should any interruptions arise on or near the set.

Estimated Budget: Production Days: Estimated Personnel Per Day:
Local Palm Beach County Crew:

By signing this application, the applicant acknowledges and agrees to the insurance and indemnification provisions: Evidence of insurance issued by companies satisfactory to the County, naming the County, and Municipality and Taxing District in which filming will be conducted as additional insured's, in the minimum amount of $1,000,000 for general liability and vehicle liability, and workman's compensation insurance as required by Florida statutes, must be provided with the application. Some municipalities or activities may require additional insurance.

The applicant agrees to indemnify and save harmless the County, each Municipality and Taxing District in which activities are conducted, their agents, servants, and employees from and against all claims, liability, losses, and/or cause of any actions which may arise from any negligent act or omission of the applicant, its agent, servants, or employees.

The applicant further agrees to indemnify save harmless and defend the County and each Municipality in which activities are conducted, their agents, servants, and employees from and against any claims, demands, or cause of action of whatsoever kind or nature arising out of any conduct or misconduct of the applicant not included in the paragraph above and for which the County or Municipality, their agent, servants, or employees are alleged to be liable.

The applicant agrees to immediately pay the County, each Municipality, Taxing District for any services provided by them at their usual rates. The Film and Television Commission will provide coordination and advise the applicant of estimated costs.

Production Company: Applicant:	Date:
By Name/Title:	Film Commission Approval Name/Title:
Signature:	Signature

Note for internet users: If you submit the form via internet then the bottom signature line is not required.

Office Use Only

Each Municipality, Taxing District and/or County Department	Contact Person

Additional Requirements or Instructions: The production company will not impede on the public. If shooting or using private or leased property, or the signage of private or leased property, permission must be obtained from the property owner prior to the shoot.