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Applicant Information

Permit & Application Fee
$225 Plus Goods and Services Tax Non-Refundable
Please Note
A separate application is required for each location.
Date*
Date
Production Title*
Applicant Name*
Applicant Mobile Phone Number*
Applicant Email Address*
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Location Information

Production Type*
Filming Location*
If Riverview, include building name.
Prep Date(s)*
Date(s) of Filming*
Wrap Date(s)*
Parking Requirements
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Contact Information

Production Company
Production Company Name*
Production Company Address*
Including City and Postal Code
Production Company Phone Number*
Production Company Fax Number
Production Company Email Address*
Parent Company
Parent Company Name
Parent Company Address
Including City and Postal Code
Parent Company Phone Number
Parent Company Email Address
Location Manager
Location Manager Name*
Location Manager Cell Phone Number*
Location Manager Email Address*
Assistant Location Manager
Assistant Location Manager Name
Assistant Location Manager Cell Phone Number
Assistant Location Manager Email Address
Production Manager
Production Manager Name*
Production Manager Cell Phone Number*
Production Manager Email Address*
Insurance & Business Licence
Current Insurance on File*
1. Yes
2. No
Current Business Licence on File*
1. Yes
2. No
Business Licence Number
Business Licence Issue Date
Business Licence Issue Date
Business Licence Expiry Date
Business Licence Expiry Date
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Special Effects

Conditions of Filming - Refer to Filming Guidelines

The Applicant agrees it will take full responsibility for ensuring that all activity performed in and around the assigned filming location is done in an appropriate and safe manner and that the activity is restricted to the assigned area(s). The Applicant further agrees to abide by the conditions of this application and all City of Coquitlam filming guidelines and all applicable Federal and Provincial laws and applicable municipal bylaws.
The Applicant also hereby relinquishes all rights to make any demand, or claim, or institute legal proceedings or litigation for any loss, damages, costs, actions, causes of action, claims, debts, demands and promises against the City. No litigation or claim will therefore be initiated against the City by the Applicant relating to the Project. Further, except where caused by the sole negligence or willful misconduct of the City of Coquitlam or its servants or employees, the Applicant agrees to indemnify and save harmless the City of Coquitlam, its elected and appointed officers, agents, servants and employees from and against all liability, claims, damages, losses, costs, actions, causes of actions, suits, proceedings expenses and demands of every kind, description and nature whatsoever, including legal fees and disbursements on a solicitor and own-client basis arising out of or in any way connected with the issuance of this permit, the conduct of the Project or use of the City of Coquitlam’s properties in the course of completing the Project.
The personal information collected on this form is collected in accordance with the Freedom of Information and Protection of Privacy Act. The City has authority to collect your information for the purposes of administering the Application to Film. Should you have any questions or concerns about the collection of your personal information, please call the Film Office at 604-927-3548.
Acknowledgment*
By checking here, the Applicant is acknowledging that it is aware of the contents of this application, including the waiver and release and agrees that it has been advised to seek legal counsel in respect of the same.
1. I accept.

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

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Application to Film

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Applicant Information

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Special Effects

Conditions of Filming - Refer to Filming Guidelines

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