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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.

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.]

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

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If different than above

If different than above

If different than above

If different than above

if any

$
$

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

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

Required for permit issuance

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

udf_135
udf_131
udf_234

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

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 Westchester148 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.

* Indicates a required field.