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City and Borough of Juneau Film Permit Request
Business and/or Individual Name #1
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Address
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Email
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Phone
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Add Another Business/Individual
Business and/or Individual Name #2
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Address
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Email
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Phone
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Scope of Project
Location 1
Date
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MM slash DD slash YYYY
Time
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Location
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Proposed Activities
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Number of People on Location
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Exclusive Use
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No
Yes
If exclusive use is requested, please explain.
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Add Another Location
Location 2
Date
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MM slash DD slash YYYY
Time
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Location
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Proposed Activities
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Number of People on Location
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Exclusive Use
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No
Yes
If exclusive use is requested, please explain.
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Add Another Location
Location 3
Date
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MM slash DD slash YYYY
Time
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Location
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Proposed Activities
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Number of People on Location
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Exclusive Use
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No
Yes
If exclusive use is requested, please explain.
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Stunts/Special Effects
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None
Pyrotechnics
Hazardous Materials
Riparian Area
Aerial Stunts
Domestic Animals
Wild Animals
Developed Recreation Site
Other
If stunts/special effects proposed, please explain.
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Other Comments for CBJ Staff to Consider
Please read through the following conditions:
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. 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 the locations, dates, and times agreed upon and listed.
3.
Insurance:
Insurance coverage as described below 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. CBJ 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 CBJ, 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 CBJ relating to this permit. The obligations of Permittee arise immediately upon actual or constructive notice of any action, claim, or lawsuit. CBJ 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 CBJ Property.
6.
Damages:
The Permittee shall pay the CBJ for any damage caused to CBJ Property associated with the Permittee’s use of CBJ Property.
7.
Not Exclusive:
Unless otherwise stated, this permit does not give the Permittee an exclusive right to use the CBJ property. Fees may be assessed for special purposes and/or City 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 CBJ 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 CBJ as determined by the CBJ Manager.
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 A.S. 22.10.040.
13.
Counterparts:
This Agreement may be executed in counterparts, each of which constitutes one and the same agreement.
Insurance Requirement
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 and appropriate insurance policy endorsements with a carrier or carriers satisfactory to CBJ covering injury to persons and/or property suffered by CBJ 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 permit, 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. This amount must be at least one million dollars ($1,000,000.00) per occurrence, and two million dollars ($2,000,000.00) aggregate. The CBJ shall be named additional insured for this policy.
Business Automobile Insurance:
$1,000,000 per accident combined single limit covering owned, non- owned and hired automobiles.
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) and City, 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.
Proof of Coverage and Insurance
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Upload
Commercial General Liability Insurance
coverage;
Business Automobile Insurance
coverage; and proof of
Worker's Compensation Insurance.
Drop files here or
Select files
Accepted file types: pdf, Max. file size: 50 MB.
By submitting this form, I agree all information is accurate and agree to the above outlined conditions. Submission of this film permit request is NOT approval by the City and Borough of Juneau. I understand that staff will review my application, follow up with quesitons, and will issue me permission if my application is reviewed and approved.
Digital Signature of Business Representative and/or Individual #1
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First
Last
Digital Signature of Business Representative and/or Individual #2
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First
Last
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