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2. This application and your certificate of insurance must be received in our office before filming can begin. Please have your permit available at all times while on location.
4. Production Company*
6. Address*
7. City/State/Zip*
9. Application/Contact Person*
10. Title
12. Phone*
13. Fax
14. Alternate Phone
16. Email*
18. Client/Agency
20. Address
21. City/State/Zip
23. Phone
24. Fax
25. Website
27. TYPE OF PRODUCTION *

    1. Feature Film
    2. Television

    1. Commercial
    2. Infomercial

    1. Music Video
    2. Corporate/Industrial

    1. Still Photography
    2. Student Project
29. Production Title:
31. General Description of the Production: *
33. Special Effects

    1. Special Effects/Pyrotechnics

    1. Animals

    1. Stunts

    1. Airplanes/Helicopters/Boats
35. What type of Animal?
37. LOCATIONS
    (Please submit additional locations in an attachment, including maps if available, Parking fees may apply.)
39. Location documents
41. Location #1
43. Dates:
44. Times:
46. Location #2
48. Dates:
49. Times:
51. Location #3
53. Dates:
54. Times:
56. ADDITIONAL COUNTY ASSISTANCE

    1. Off-duty Deputies

    1. Street/Sidewalk Closing*

    1. Parking

    1. Fire Department

    *An additional permit is required when closing a street or sidewalk/walkway and must be approved by Sumter County, or appropriate municipality.
58. INSURANCE
    A copy of the certificate of insurance in the amount of $1,000,000 must be submitted to Administrative Services for the application to be processed. Certificate Holder should be: Sumter County Board of County Commissioners, 7375 Powell Rd., Wildwood, FL 34785.
    
    Please note-private property owners may have additional insurance requirements.
60. Copy of Insurance
64. ECONOMIC IMPACT
66. Arrival Date
67. Departure Date
68. Total # Production Days
70. PLEASE LIST BELOW AMOUNT SPENT IN SUMTER COUNTY:
72. Hotel/Property Name(s):
74. Date:
75. Rooms Booked
76. Date
77. Rooms Booked
79. Date
80. Rooms Booked
81. Date
82. Rooms Booked
84. Date
85. Rooms Booked
86. Date
87. Rooms Booked
89. Total # of Rooms Booked at Hotels/Apartments/Condos
91. Number of Technicians & Labor/Local Hires
93. Number of Actors-Extras/Local Hires
95. Rental (Equipment/Studio/Stage)
97. Location Fees
99. Post Production Services
101. Total Amount Spent within Sumter County
103. Approximate TOTAL Project Budget (Overall)
105. Production Company Representative *

     By checking this box below, the applicant shall assume all risk in the use of County property in the permitted operation and shall be solely responsible and answerable in damages for all accidents and injury to person or property and shall indemnify and keep harmless the County and its officers and employees from any and all claims, suits, losses, damages or injury to person or property

     1. I Accept

     1. I Do Not Accept
107. Date *
     Date
111. STAFF ONLY AREA
113. Economic Development Director or County Administrator Approval:
Leave This Blank:


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

     This field is not part of the form submission.

117. Submit

* indicates a required field