Charlotte Harbor

Charlotte Harbor Florida Film Office 18501 Murdock Circle, Suite 502 Port Charlotte, FL 33948 941-743-1900 941-743-2245 Fax
*Production Company:

*Contact Person:

*Company Address: (please include apartment or suite number)

*City:
State:
Province/Territory (if Canadian):
*Country: Country (other than above):
*Postal Code:
Phone:
Fax:
E-mail:
Local Address:
Local Phone:
Type of Production: Film Commercial Video Music Still Other (please describe below)
Description (if other selected above):
If feature film, please list working title:
If commercial, please list product/service:
PRODUCTION DATES Arrival Date:
Departure Date:
Estimated total # of production days:
BUDGET INFORMATION Approximate Project Budget:
Estimated budget to be spent within Charlotte County:
CAST/CREW Number of local cast hired:
Number of total crew:
HOTEL ROOMS Name of Hotel:
Number of rooms booked:
Dates: thru
LOCATIONS Location #1 requested:
Location #1 Dates: thru
Location #1 Time:
Location #2 requested:
Location #2 Dates: thru
Location #2 Time:
If more than two locations are needed, please enter below:
INSURANCE By signing this application the applicant acknowledges and agrees to the following insurance and indemnification provisions: 1) Evidence of insurance issued by companies licensed by the State of Florida and satisfactory to the municipalities/county, naming the municipalities/county in which filming will be conducted as additional insured in the minimum amount of $1,000,000 for general liability and vehicle liability: $5,000,000 for special effects, explosives, or other potentially hazardous filming. (2) Florida statutes require workman compensation insurance for all prime and subcontractors: The applicant agrees to indemnify and save harmless the municipalities/county in which activities are conducted, their agents, servants, and employess from and against any claims, demands, or causes of action of whatever kind or nature arising out of any conduct or misconduct of the applicant and for which the municipalities/county, their agents, servants, or employees are alleged to be liable. Agreed to by production company representative/applicant:
*Name:
Title:
*Date:
*required information