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Applicant Information

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

Contact Information

Production Company
Production Company Name*
Production Company Address*
City*
Province/State*
Postal Code/Zip Code*
Production Company Phone Number*
Production Company Email Address*
Parent Company
Parent Company Name*
If Other, specify company name
Streaming Service*
If Other, specify streaming service
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 and Business Licence
Current Insurance received by the City*
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

Special Effects Coordinator
Special Effects Coordinator Name
Special Effects Coordinator Cell Phone Number
Special Effects Coordinator Email Address
Special FX
Special FX
1. Yes
2. No
Exterior Atmospheric Smoke*
1. Yes
2. No
Requirement - Pyrotechnics Permit Application
Requires a completed Pyrotechnics Permit Application (PDF) to be submitted by email to Coquitlam Fire/Rescue and Coquitlam Film Office.
1. I accept.
Interior Atmospheric Smoke*
1. Yes
2. No
Requirement
Requires an email to be sent to Coquitlam Fire/Rescue, advising them at least 3 days prior to the date of FX.
1. I accept.
Type of FX
Additional Details
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Conditions of Filming

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.

Leave This Blank:

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

This field is not part of the form submission.
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