Film Location Application

Type of project:

Type of project: Film Video Photo
Project Title:
Production Company:
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
VU Contact Person
Production Manager/Coordinator:
Email
Phone Phone - ### - ### ####
Set-up/Strike Date(s):
Shoot Date(s):
Hours Requested:
Number of Cast/Crew:
Location(s) Requested:
Requested: Special Service Needs
(electrical, security, catering, on-campus parking, etc.):
Insurance Requirements: Production Company must be able to provide no less than $2,000,000 of general liability insurance with limits of $2,000,000 per occurrence, no less than $1,000,000 of auto liability insurance, and if Production Company employs five or more persons, proof of worker's compensation insurance. Please provide a certificate of insurance that lists Vanderbilt University as an additional insured and evidences the existence and amounts of such insurance to Vanderbilt before using the premises.
If you cannot meet this requirement, what liability amount(s) do you have?
Specific Details of Project
(e.g., purpose, how content will be used, where project will be featured):
Please check each box to show that you understand and agree to the following terms:

Please check each box to show that you understand and agree to the following terms: Any substantive change in the above information will require resubmission of application. The use of the Vanderbilt premises is for location only. Vanderbilt University cannot be recognizable in the film, video or photography without the permission of the Division of Communications. Production company will adhere to Vanderbilt’s protection of minors policy and perform background checks on all personnel on our premises. Production company will accept full responsibility to the university for the acts and omissions of all persons, whether directly or indirectly employed, while on campus. If granted permission to access university locations, I must execute a location agreement, provide a certificate of insurance and pay any applicable fees before production may begin. I have read and understand these guidelines and agree to the requirements set forth in this document.
If the film or video box is checked, the completed application should be accompanied by a copy of the script/storyboard with the scene(s) to be shot at Vanderbilt highlighted.

Attach Files
If the photo(s) will be used commercially, a rough layout of the proposed ad or printed collateral showing the specific text that will be associated with any image(s) of the Vanderbilt campus must be submitted.

Attach Files
Date Date / MM / DD YYYY
Please submit completed application at least 30 calendar days prior to your first prep or shoot day.

Draw or Type

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Full Name

I understand this is a legal representation of my signature.