Film Permit ApplicationDate:
For the University to review a Film Permit Application, we requirea non-refundable $250 fee, and a copy of your script with your submission of the Application.
Please make the check payable to the Regents of the University of California. Send completed Application, Script, and the $250 check to Procurement Services, 3203 SAASB, Santa Barbara, CA 93106-1150.
Type of project Production filming Still photography
Documentary/Educational film Student project
Company/Individual Name Phone
AddressEmail
City State Zip
Web address
Project TitleProject Type
Producer Cell #
Director Cell #
Location Mgr/AssistantCell #
Proposed use and distribution of the project:
Name of sponsoring campus department, if any
For Student Projects, Course Name and Advisor
ContactPhone #
Desired Locations (list in priority order and include proposed modifications/alterations to the campus; use a separate sheet of paper if necessary):
Activities/Action (include camera/equipment placement, request for traffic control, etc.):
Shoot Dates and Times(include prep and strike):
Total number of days:
Total number of personnel:
Total Number of Vehicles (please specify details below):
TrucksMotor homes
AutosPicture Cars
VansCamera Cars
Catering*Generator
TrailersOther (please specify)
*UCEN and Housing Catering have first right of refusal for any catering on campus.
Pyrotechnics:
Description
TechnicianLicense # F/X Permit #
Phone #Pager #Cell #
Other Special Requirements:
Insurance
Applicant, at its sole cost and expense, shall insure its activities in connection with this film application at the minimum coverage and conditions outlined below. These limits may be revised in accordance with the recommendation of the University’s Risk Management and Insurance Administrator.
General Liability
Comprehensive or Commercial Form with Aggregate Limit (Minimum Limit):
a.Combined Single Limit Per Occurrence$1,000,000
b.Products and Completed Operations$1,000,000
c.Personal and Advertising$1,000,000
d.General Aggregate, Bodily Injury, Property Damage*$3,000,000
* not applicable to Comprehensive Form
If the above insurance is written on a claims-made form, it shall continue for three years following termination of this film permit. The insurance shall have a retroactive date of placement prior to or coinciding with the effective date of this film permit.
Business Automobile Liability Insurance for owned, scheduled, non-owned or hired automobiles with a combined single limit of not less than $1,000,000 per occurrence.
Workers' Compensation: as required under California State Law, to cover all employees, actors, and agents.
Such other insurance in such amounts which from time to time may be reasonably required by the mutual consent of University and Permittee against other insurable risks relating to performance.
The coverage referred to above shall be endorsed to include The Regents of the University of California as an additional insured. Certificates shall further provide for thirty (30) days advance written notice to the University of any modification, change, or cancellation of any of the above insurance coverage.
General
In making this application, it is understood that scenes and/or subject matter of the proposed film must not detract from the image of the University of California or its educational mission, that the name, seal, logo, or scenes identifying the University may not be used without written permission from the Vice Chancellor, Administrative Services.
Permittee hereby agrees to comply with all the rules and regulations of the facility or institution subject to this permit. If approved, acopy of the subsequent permit (this is NOT your permit) is to be maintained at the filming location at all times.
Print name of company representativeDate
Signature of company representativeProject Title
UCSB Film/Photography Permit Application – 9-2015Pg. 1 of 3