Media Permit Application Applicant InformationName First Last Date of Birth MM slash DD slash YYYY Drivers/Sate ID# Email Cell PhoneAlternate PhonePreferred Contact Method Email Text Message Phone Call Organization/Production Company On-site Contact Contact NumberSelect all that applies to you (the applicant) and your filming below Applicant producing/organizing on their own accord 501(c)(3) EIN Please choose the type of Media Permit you are requesting by checking the appropriate box belowNon-commercial filming/photographyCommercial PhotographyStudent filming/photographyFilming Level 1 (1-5 crew, talent, vendors, volunteers, etc.)Filming Level 2 (6-12 crew, talent, vendors, volunteers, etc.)Filming Level 3 (13-20 crew, talent, vendors, volunteers, etc.)Filming Level 4 (21+ crew, talent, vendors, volunteers, etc.)Filming/Photography Shoot InformationDate(s) of shoot and location(s) listed in preference order1st: Set up Date(s) 1st: Date(s) of Shoot 1st: Tear Down Date(s) 1st: Park Name 1st: Set up Time(s) 1st: Shoot Time(s) 1st: Tear Down Time(s) 1st: Special Location 2nd: Set up Date(s) 2nd: Date(s) of Shoot 2nd: Tear Down Date(s) 2nd: Park Name 2nd: Set up Time(s) 2nd: Shoot Time(s) 2nd: Tear Down Time(s) 2nd: Special Location 3rd: Set up Date(s) 3rd: Date(s) of Shoot 3rd: Tear Down Date(s) 3rd: Park Name 3rd: Set up Time(s) 3rd: Shoot Time(s) 3rd: Tear Down Time(s) 3rd: Special Location Name of Shoot Number of Participants Number of Production Vehicles Production TypeCommercialDocumentaryPhoto ShootPilotSeries (TV/Web/Mini)Short FilmStudent FilmMovieOther (Please describe)Other (Please describe) If series please choose from the options below New Returning Media Outlets/Distribution/Audience Description Equipment & Prop ListShoot Scene/Content DescriptionProposed ActivitiesVehicles & Driving: Picture vehicles Yes No Vehicles & Driving: Driving route (actor driven/camera car/process trailer): Yes No Stunt Work: Fight/fall/wire work/ratchet pull/ weapons play Yes No Stunt Work: Precision driving (chase/swerving/near misses/etc.) Yes No Stunt Work: Visible prop weapons - any cast and/or performers (principle/background) dressed as police or army: Yes No Special Effects: Exterior artificial smoke and/or fog Yes No Special Effects: Squibs/stimulated gun fires Yes No Special Effects: Rain towers/street wetdowns Yes No Special Effects: Artificial snow Yes No Additional Details: Helicopter use Yes No Additional Details: Construction on property Yes No Additional Details: Ground disturbances (digging/etc.) Yes No DronesDrones must be operated by a licensed and certified FAA pilot according to the FAA Small Unmanned Aircraft Systems (UAS) Regulations (Part 107) for drone operation rules and requirements. (See Appendix C for more information.) Drone Liability Insurance is required.Will your shoot include the use of drones? Yes No Drones: Purpose Drone License Certificate Number Amplified SoundAmplified sounds must be directed away from residences and must comply with Sections 8-32-010 through 8-32-170 of the Chicago Municipal Code. The proposed location of the sound system, direction of sound and location of all speakers must be identified on your Site Map. PLEASE NOTE: AMPLIFIED SOUND IS NOT ALLOWED IN ALL PARKS. Provide an overview of the purpose and plans for amplified sound, a description of the sound system, and a description of how you will minimize the impact of any generators used for the amplified sound system. Are you requesting permission to have amplified sound? Yes No Hours of amplified sound (including sound checks): Start Time Hours of amplified sound (including sound checks): End Time Description (DJ, Live Music, Announcements, Etc.) Noise LevelNoise levels are not guaranteed. However, the Park District requests this information with the intent to avoid disruptions of other large events taking place. Will your shoot require a location that is uninterrupted by sound/other events? Yes No Noise Level: Description GeneratorsUse of generators may require additional permitting according to Chapter 4-355 of the Chicago Municipal Code. PLEASE NOTE: GENERATORS THAT MINIMIZE THE IMPACT TO THE ENVIRONMENT ARE PREFFERED (I.E. GENERATORS THAT RUN ON BIODIESEL OR OTHER RENEWABLE OR LOW EMISSION FUELS).Will your shoot include the use of generators? Yes No Number of Generators Will the generators need to be grounded or bonded? Yes No Will the generators need to be grounded or bonded? Description Facility RequestsAdditional permit and approvals from other government agencies, insurance, and other documents may be required as determined by the Park District. Proof of compliance with the Illinois Pyrotechnic Operator Licensing Act must be attached to this application. (See Appendix C for more information.) Will your shoot include any special facility requests? Yes No Will your shoot include any special facility requests?? Description Description of Parking needs and number of spaces: Please select the type of request Indoor Electrician Outdoor Electrician Engineer Other Will your shoot include any pyrotechnic devices? Description Fireworks and PyrotechnicsRequests will be fulfilled at the discretion of Westrec SMI Manager of the Park District Harbors. Requests must be submitted at least 7 days prior to the shoot date. Will your shoot include any pyrotechnic devices? Yes No Will your shoot include any pyrotechnic devices? Description Pyrotechnic Company Pyrotechnic Company: Contact Name Pyrotechnic Company: Contact Phone Pyrotechnic Company: Onsite Contact Name Pyrotechnic Company: Onsite Contact Phone Portable ToiletsAll portable toilets must be installed and removed from Westrec SMI Manager of the Park District Harbors property during the permit times or at a time specified by Westrec SMI Manager of the Park District Harbors. All portable toilets must be located on a hard surface, which may include asphalt, concrete, or plywood. All portable toilets must be clearly identified on the Site Map and the location must be approved by the Westrec SMI Manager of the Park District Harbors prior to delivery. (See Addendum F for Accessibility Guidelines.)Will your shoot include the use of portable toilets? Yes No Number of portable toilets Number of accessible portable toilets Fencing and BarricadesThere are several locations that require locates/ designation of underground infrastructure to identify irrigation, plumbing or electrical lines in order to prevent injury or damage to the property. (See Addendum B for more information).Will your shoot include the use of fencing? Yes No Fencing: Description Will your shoot include the use of barricades? Yes No Barricade: Description MaintenanceOrganizers are responsible for cleaning and maintaining the site throughout the duration of the permit. The Chicago Park District does not guarantee the availability of cans / liners at the site. Please plan accordingly. Permittee is responsible for all costs incurred by Westrec SMI Manager of the Park District Harbors arising from emergency repairs / maintenance due to the Permittee’s activities in order to return the site to a clean, slightly, and safe condition. Describe the waste management/trash/recycling removal and Maintenance plan belowWritten description prepared by the event organizer, of Westrec SMI Manager of the Park District Harbors maintenance staff or a professional trash hauler will remove refuse/recyclables before, during and after the event from Westrec SMI Manager of the Park District Harbors property in a safe and legal manner. The plan should also detail materials that will be recycled or composted and plan to provide sufficient collection infrastructureTents and CanopiesTents and/or canopies over 400 square feet are only allowed on Westrec SMI Manager of the Park District Harbors property with a permit from the City of Chicago Department of Buildings (DOB). When you apply for a tent and/or canopy permit with the DOB, you will be required to submit a letter from Westrec SMI Manager of the Park District Harbors verifying the quantity and dimensions of tents and/or canopies larger than 400 square feet. Please plan accordingly by submitting all appropriate paperwork (including the letter of support from Westrec SMI Manager of the Park District Harbors) to DOB at least 60 days prior to your permit date. (See Addendum B for more information.) The event organizer is responsible for any damage caused to park property/facility and must consult staff prior to installation. (See Appendix C for more information.) A copy of all permits issued by DOB must be submitted before the submission deadline; otherwise, late fees may apply. Will your shoot include the use of tents and/or canopies over 400 square feet? Yes No Total quantity of tents and/or canopies over 400 sq. ft Provide the dimensions in feet (length x width) and details below or attach a sheet with the related information. If you don't have the information at the time of submitting the application, please indicate in the below box and provide the information at a later date.Will your shoot include the use of tents and/or canopies under 400 square feet? Yes No Total quantity of tents and/or canopies under 400 sq. ft Please indicate the quantity of each: 10 X 10 15 X 15 20 X 20 Other Stages and PlatformsWill your event include the use of stages and/or platforms over 2 feet tall and covering more than 400 square feet and/or with any roofing/wings? No Yes Total quantity of stages and/or platforms over 2 feet tall and covering more than 400 square feetand/or with roofing/wings: Provide the dimensions in feet (height x length x width) and details below or attach a sheet with the related information. If you don't have the information at the time of submitting the application, please indicate in the below box and provide the information at a later date.Will your event include the use of stages and/or platforms under 2 feet tall and/or with any roofing/wings? No Yes Total quantity of stages and/or platforms under 2 feet tall and/or with roofing/wings: Please indicate the dimensions of each:Height (ft.) Length (ft.) Width (ft.) Height (ft.) Length (ft.) Width (ft.) Other StructuresMust be approved by Westrec SMI Manager of the Park District Harbors and may require a separate building permit from the city of Chicago Department of Buildings (DOB). If a building permit is required, a letter from the Park District verifying the number and dimensions will be needed before THE DOB will issue a permit. A copy of all permits issued by THE DOB must be submitted to Westrec SMI Manager of the Park District Harbors prior to your event. Please plan accordingly by submitting all appropriate paperwork to DOB at least 60 days prior to your event day. Will your shoot include the use of other structures (e.g. climbing walls, rides, etc.) ? Yes No Other Structures: Total Quantity Other Structures: Description StakingThere are several locations that require locates/designation of underground infrastructure to identify irrigation, plumbing or electrical lines in order to prevent injury or damage to the property. Damage repair costs and permit violation fines are the responsibility of the applicant. Additionally, the applicant is responsible for Staff/Contracted Vendor costs to conduct locates and irrigation inspections. Staking of tents in these locations may be restricted or denied. Will any of the shoot features or structures be staked in the ground? Yes No Type of stakes Length of stakes Total quantity of features and/or structures to be staked Staking: Description Security ServicesDepending on the size and activities of your proposed shoot, the Park District may require the presence of security personnel. Additionally, the City of Chicago may require security services or make revisions to your security plans. Furthermore, you are You are responsible for any costs incurred by the Westrec SMI Manager of the Park District Harbors. Please note: all security plans must be approved by Director of Security or his/her designee. Additional information may be requested upon review of any and all security plans. Have you made provisions for on-site security services? Yes No Security Company Security Company: Contact Name Security Company: Email Address Security Company: Contact Phone Security Company: On-Site Contact Name Security Company: On-Site Contact Phone Site MapAttach a site map or create a site map below that indicates the location of the following: all sources of amplified sound and direction of sound; tents and canopies with sizes; stages, promotional vehicles, inflatables, portable toilets, dumpsters, fences & barricades, generators, and other structures; proposed driving paths for all equipment and supply vehicles; location of vehicles you wish to retain on property during the shoot; and proposed street closures. All Site Maps are subject to the approval of Westrec SMI Manager of the Park District Harbors.Upload Site Map (pdf, gif, and jpg) Drop files here or Select files Accepted file types: jpg, gif, pdf, Max. file size: 256 MB. SignatureBy signing this Media Permit reservation application, I acknowledge that I have read and agree to abide by Chicago Park District Codes permit rules and regulations, including the cancellation policy. I also agree that I am solely responsible for the actions and conduct of my guests, invitees, participants, spectators, contractors and for assuring compliance with all applicable rules and regulations pertaining to my permit. I understand and agree that my security deposit shall be forfeited for any violation of this agreement. I hereby assume all responsibility for and agree to indemnify, save and hold harmless, and at the Chicago Park District’s and Westrec SMI option, defend the Park District and Westrec SMI, its Commissioners, officers, employees, volunteers, contractors and agents (collectively, the “Indemnitees”) against any losses, claims, damages, liabilities, actions, suits, proceedings, costs or expenses that the Indemnitees may suffer, incur or sustain or for which it or they may become liable resulting from, arising out of or relating to any negligence or intentional misconduct by myself as applicant, and any guests, invitees, participants, spectators, including any officers, employees, contractors, agents or persons under a sponsoring organization’s control in connection with this permit. My obligation to indemnify the Park District and Westrec SMI Indemnitees shall survive the expiration or termination of this permit. I do solemnly swear that all answers given and statements made on this application are full and true to the best of my knowledge. I am 18 years of age or older and I have read the terms and conditions set forth in this document and the Chicago Park District Code and Chicago Harbors Code agree to abide by them.Name of Applicant (Please Print) SignatureDate MM slash DD slash YYYY