Letter of Intent

Production information

Complete the form below if you are interested in pursuing any commercial activities related to photography, film, videotaping or any other media production. The Film Office will provide the most up-to-date requirements necessary for the municipality in which you are interested in working.

IMPORTANT NOTE: Please be as specific, accurate and complete as possible as this information will be used to assess your request and to generate your permit documents, if and when issued.

*** Please turn off your "caps lock" and use standard capitalization when completing this form. ***

Project name (or working title)*:

Full LEGAL name of production*:

REQUIRED: Specify "LLC," "Inc.," etc. This will be the entity named on your film permit and MUST match your insurance and compliance documents. [Students: Use the name of your school.]

Company contact first name*:

Company contact last name*:

Applicant/contact job title*:

e.g., location manager, assistant location manager, UPM, producer, director

Company contact email address*:

It is okay to contact me via email*:

Yes No

Phone*:

On-location contact name:

If different than above

On-location contact job title:

If different than above

On-location contact phone:

If different than above

On-location contact email:

If different than above

Company address*:

City*:

State*:

Zip*:

Country*:

Fax:

if any

Total production budget*:

Potential economic impact:

Project & scene descriptions:

Please provide a VERY BRIEF summary of the project and description of scene(s) for your permit

Type of production*:

If other, please specify:

Have you already identified your desired location?*:

Yes No

If so, where? If not, describe your needs*:

Notes/requirements on location:

Please list specific areas of the location(s) to be used, and provide as many details as possible

Upload map/diagram (strongly recommended):

Dates & times*:

Required for permit issuance

Total cast & crew size*:

Number of people including ALL cast, BG, crew, catering/crafty, drivers, etc.

Equipment:

Vehicles:

Any traffic control or disruption to local activity?*:

Yes No

If so, briefly describe:

Any weapons, incendiary effects or police/military wardrobe?*:

Yes No

Are you using a vendor for tent(s) on County property?*:

Yes No

If so, provide name & address, contact name, title & email:

We will send your vendor a tent permit for signature, and insurance requirements.

Will you provide craft/food services on location?*:

Yes No

Craft/food services vendor(s):

List contact name(s), phone number(s) and email addresses for all catering/craft services vendors

Do you need referrals for hotels, catering services, etc.?:

Any questions for us?:

What brought you to Westchester for locations?:

Summary of insurance requirements

ALL productions on the property or otherwise under the jurisdiction of Westchester County, including student and non-profit productions, MUST provide:

1. A valid certificate of insurance, including:
A. Minimum coverage:
• commercial general liability insurance with a minimum combined single limit of
$1 million per occurrence and a minimum aggregate limit of $2 million;
• automobile liability insurance with a minimum limit per occurrence of $1 million
for bodily injury and $100,000 for property damage; AND
• $2 million umbrella/excess coverage.
B. “County of Westchester, 148 Martine Ave., White Plains, NY 10601” named as an additional
insured, with waiver of subrogation, for all three of the above; be sure the issuer of the
COI checks the corresponding boxes under “ADDL INSD” and “SUBR WVD” for each policy.
C. In the Description of Operations, this statement:
“Certificate holder is included as additional insured on a primary & non-contributory
basis including Workers Compensation.”
D. For student productions, both the Permittee and the County named as additional insureds.

2. Proof of workers compensation insurance and disability benefits on NYS forms C-105.2 and DB-120.1,
naming the Permittee and listing "County of Westchester, 148 Martine Ave., White Plains, NY 10601" as
the requesting entity in box #2. New York State statutory limits apply. Forms SI-12, GSI-105.2 or CE-200
may be accepted, if applicable.

If you fail to use the exact forms, wording and address specified here, your permit may be delayed or denied.
Additional insurance may be required depending the nature of the project.
Complete requirements are specified in Schedule B of your location agreement and permit.

I have read and understood the insurance requirements. (REQUIRED)

Food service safety requirements

Productions shall comply with applicable provisions of the New York State and Westchester County sanitary codes relating to food service at the production location(s). Permittee agrees to immediately remediate violations, if any, issued by the Westchester County Dept. of Health relating to food service at the location(s). You can apply for a temporary food service permit here.

I have read and understood the food service safety requirements. (REQUIRED)

* Indicates a required field.