2. Film Production Protocol
   Please complete the following questionnaire. For more information contact the Town Administrator rrainer@portsmouthri.com or call (401) 683-3255. A signed location agreement and Certificate of Insurance will be required under most circumstances. Permits which may be required include: Street/Sidewalk Closing Permit; Reserve Parking/No Parking Permit; or Special Events Permit (for any work done in a Town park). Screen credit to the Town of Portsmouth is assumed. Early coordination is the key to accommodating the particular needs of your production, so please provide as much notice as possible.
4. Procuction Company Information
6. Name of Production Company*
8. Primary Point of Contact
10. First Name*
11. Last Name
13. Address*
15. PO Box, apt, Unit, etc.
17. City*
18. State*
19. Zip*
21. Primary Phone Number*
22. Type

    1. Home
    2. Office
    3. Cell
24. Other Phone Number
25. Type

    1. Home
    2. Office
    3. Cell
27. Email*
29. Project Information
31. Project Name*
33. Start Date---------------------------------Completion Date
    Start Date---------------------------------Completion Date Start Date

    —

    Start Date---------------------------------Completion Date End Date
35. Media Type*

    1. Film/Video
    2. Still Photo
    3. Television
    4. Online (web, YouTube, etc)

    Select ALL that apply
37. Description or Story Line*
39. Crew Size*
40. Cast Size*
42. Decription of vehicles and production equipment to be used (or enter :none")*
44. Notable talents that may have media interest (or enter "none") *
46. Town Facilities Requested
48. Town Streets Involved*
    Enter Street and range of addresses affected
50. Town areas to be used (e.g., Glen Park, Glen Manor House, Glen Farm Special Events Field, etc.)*
    Provide details (such as any access restrictions, etc.)
52. Other Services Needed*

    1. Street/Sidewalk Closure
    2. Reserved Parking
    3. None
54. The follwing Services may be required (extra fees may apply per town policies)*

    1. Police/Traffic Control (If blocking public streets or impeding traffic flow)
    2. Harbormaster (if coastal waters used)
    3. Public Works (If any town buildings or structures used)
    4. Recreation Department (if Town Recreation Areas to be used)
    5. None

    Check ALL that may apply
56. Other Services Needed (Specify)
58. Upload additional Information if desired
    Please upload additional information including project itinerary, dates/times, locations that will help the Town review your request
60. Type in First Name, MI, Last Name*
    I CERTIFY THAT THE ABOVE INFORMATION IS CORRECT TO THE BEST OF MY KNOWLEDGE AND THAT KNOWINGLY SUPPLYING FALSE INFORMATION IS PUNISHABLE IN ACCORDANCE WITH TOWN, STATE AND FEDERAL LAWS
61. Date/Time Signed*
    Date/Time Signed

    Date/Time Signed
63. Town Internal Actions Required.
    Town Codes receiving this email should log into the CivicPlus "Form Center Module", "Town Other On-Line Forms", "Film Production Protocol" form and select "Action" for required Town action.
Leave This Blank:


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

    This field is not part of the form submission.

74. Submit

* indicates a required field