Production Title. Production Schedule Date Purpose Bump In, Rehearsal, Performance , Bump Out Start Time Finish Time I, _________________________ of declare that I am authorised to act on behalf of the above named hirer. The hirer agrees that the said premises shall be used for the production as listed above and for no other purpose. I now pay the sum of $250 ($125 community rate) as security deposit on account of such hiring and agree that the hirer shall promptly and punctually pay MidCoast Council all monies which may be payable in respect of this hiring, in accordance with the Council's Terms and Conditions of Hire and Schedule of Fees and Charges. The hirer agrees to be bound by and shall observe, perform and fulfil the requirements of the Terms and Conditions of Hire.
Production Title. Production Schedule Date Purpose Bump In, Rehearsal, Performance , Bump Out Start Time Finish Time I, _________________________ of declare that I am authorised to act on behalf of the above named hirer. The hirer agrees that the said premises shall be used for the production as listed above and for no other purpose. I now pay the sum of $250 ($125 community rate) as security deposit on account of such hiring and agree that the hirer shall promptly and punctually pay MidCoast Council all monies which may be payable in respect of this hiring, in accordance with the Council's Terms and Conditions of Hire and Schedule of Fees and Charges. The hirer agrees to be bound by and shall observe, perform and fulfil the requirements of the Terms and Conditions of Hire. Signature of Applicant - ___________________________________ Date - ___________________ Yalawanyi Ganya 0 Xxxxxx Xxx PO Box 482 Taree NSW 2430 Creditor details verification form All invoices must be in the name of MidCoast Council ABN 44 961 208 161 Please send ALL invoices to the following email address only and not directly to the Council officer. Invoices must include either a Purchase Order Number or a staff members name. xxxxxxxx.xxxxxxx@xxxxxxxx.xxx.xxx.xx Company name Trading name Mailing address Accounts contact person Accounts contact phone number Accounts contact email address Remittance email address Purchase Order email address ABN Registered for GST Goods or Service: Providing a service to Council Providing goods only Banking details BSB Account number Account name If you need to enquire about an invoice or payment, please contact our Accounts Payable team on 7955 7012. Privacy: This information is required to assist with your application and will not be used for any other purpose without seeking your consent, or as required by law. Your application will be retained in our Records Management System and disposed of in accordance with current legislation. Your personal information can be accessed and corrected at any time by contacting us. MidCoast Council | Yalawanyi Ganya | 0 Xxxxxx Xxx Xxxxx | PO Box 482 Taree Phone 00 0000 0000 | xxx.xxxxxxxx.xxx.xxx.xx
Production Title. Artists Agent: .................................................................................. Address: .................................................................................. Address: .................................................................................. .................................................................................. .................................................................................. .................................................................................. .................................................................................. Telephone: .................................................................................. Payment for w/e: .................................................................................. Eps. Nos. .................................................................................. % Mon Tue Wed Thur Fri Sat Sun Weekly Total Date Basic Negotiated Rate Payment for Rights Contracted Overtime TOTAL FEE: Overtime/Additional - Overtime Penalty Payments Cancellations Postponements Rehearsals Wardrobe Calls Travel Days Post Sync Annual Leave Allowances Other TOTAL GROSS: Less: Tax Less: Other Add: Other NET PAYMENT TO AGENT Pay Advice Form For Extras SCHEDULE C Production Company: .................................................................................. Artists Name: ..................................................................................
Production Title. Artists Agent: .................................................................................. Address: .................................................................................. Address: .................................................................................. .................................................................................. .................................................................................. .................................................................................. .................................................................................. Telephone: .................................................................................. Payment for w/e: .................................................................................. Eps. Nos. .................................................................................. Mon Tue Wed Thur Fri Sat Sun Weekly Total Date Basic Negotiated Rate Contracted Overtime TOTAL FEE: Overtime/Additional - Penalty Payments Cancellations Postponements Rehearsals Wardrobe Calls Travel Days Annual Leave Allowances Other
Production Title. The undersigned Production Company has requested a filming permit from Clackamas County for the limited purpose of: □ Television □ Motion Picture/Feature □ Commercial Photography □ Music Video □ Documentary □ Educational □ Commercial □ Other: The undersigned is required to provide a Release and Hold Harmless Agreement from and defend against any and all claims, lawsuits or other liability arising from as a result of the activity, event or use relating to the permitted activity. The undersigned acknowledges and affirms that the County has agreed to permit such activity subject to condition and requirements outlined in the permit application and guidelines and as follows: Permittee shall agree to, and does hereby agree to indemnify, defend and hold harmless, the County, its Commission, agents, officials and employees from and against any and all claims, loss, liability, damages, costs and expenses, including, but not limited to, any and all liability for damage to property and/or any and all liability for personal injury or death as a result of the activity, event or use provided for in this Permit and/or as a result of participation in or attendance at the activity, event or use provided for in the Permit, caused by the negligent acts, errors, or omissions of the Permittee, its agents, subcontractors, or employees, or others, regardless of whether or not Permittee alleges such claim, loss liability, damage, cost or expense, is cause or contributed to, in part, by the County. Signature: Printed Name: Company: Title: Dates of Filming: From: _ To: Time of Day: From: □ am □ pm To: □ am □ pm STATE OF OREGON COUNTY OF CLACKAMAS This instrument was acknowledged before me on this day of , 20 by _(name of person) as (title) of (company name). NOTARY PUBLIC Print Name:
Production Title. Canada in a Day Information of person appearing in the Video: Name (PRINTED): Province: Telephone: ( ) AGE: Email: Signature: Production Title: Canada in a Day
Production Title. If feature film or television, list working title. If commercial, list product/service. GENERAL DESCRIPTION OF THE PRODUCTION Productions may be required to submit a copy of the script upon request. LOCATIONS: Please submit additional locations in a separate attachment Location #1: Dates: Times: Location #2: Dates: Times: Location #3: Dates: Times: Location #4: Dates: Times: Location #5: Dates: Times: Location #6: Dates: Times: *If filming B-roll, please list location as ‘General B-Roll (Insert city or municipality you are filming). Example: General B-Roll City of Tampa. PRODUCTION ACTIVITY
Production Title. Production Schedule Date Purpose Bump In, Rehearsal, Performance , Bump Out Start Time Finish Time I, _________________________ of declare that I am authorised to act on behalf of the above named hirer. The hirer agrees that the said premises shall be used for the production as listed above and for no other purpose. I now pay the sum of $250 ($125 community rate) as security deposit on account of such hiring and agree that the hirer shall promptly and punctually pay MidCoast Council all monies which may be payable in respect of this hiring, in accordance with the Council's Terms and Conditions of Hire and Schedule of Fees and Charges. The hirer agrees to be bound by and shall observe, perform and fulfil the requirements of the Terms and Conditions of Hire. Signature of Applicant - ___________________________________ Date - ___________________ CREDITOR DETAILS VERIFICATION FORM When completing this form: - Use a blue or black pen; - Use BLOCK LETTERS; - Print only and write clearly. COMPANY NAME TRADING NAME MAILING ADDRESS ACCOUNTS CONTACT PERSON CONTACT PHONE NUMBER CONTACT EMAIL ADDRESS REMITTANCE EMAIL ADDRESS ABN REGISTERED FOR GST YES NO BANKING DETAILS BSB ACCOUNT NUMBER ACCOUNT NAME OFFICE USE ONLY CREDITOR NUMBER VERIFYING OFFICER
