Hawaii Film Office

1) LOCATION*

LOCATION PROJECT NAME Time Island

2) - (LOCATION MAP) SATELITTE Mode -highlight area of interest.*

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GOOGLE SATELLITE IMAGE - USE BELOW WEBSITE TO DETERMINE LANDOWNER. http://histategis.maps.arcgis.com/apps/webappviewer/index.html?id=7981e1cc5fc14bb487751acc7e74ef6b

3a) START DATE*

NO weekends or state/federal holidays at DLNR STATE PARKS & TRAILS.

3b) END DATE*

No weekends or state/federal holidays at DLNR STATE PARKS & TRAILS.

3c) MULTIPLE SHOOT DATES FOR LOCATION

Example 9/7/18 , 9/10/18 , 9/12/18 weather - No weekends or state/federal holidays at DLNR STATE PARKS & TRAILS.

4) TOTAL NUMBER OF CAST AND CREW ON LOCATION*

5) DESCRIBE FILMING ACTIVITY IN DETAIL*

5a) ACTIVITY DOCUMENTS IF APPLICABLE

6) EQUIPMENT OR PROPS USED ON LOCATION*

7) NUMBER OF VEHICLES*

Crew Car	Camera Car	Picture Car	Van	Truck	Generator Truck	Motor Home	Tower Platform	40' Truck	Other Trucks

Type in number of vehicles on set or describe vehicle in other.

8) PARKING PLANS- Ex. public parking where available*

9) WATER ACTIVITY?*

YES
NO

BOAT, JETSKI, OR DRONE NEAR OCEAN WILL NEED TO CHECK YES TO WATER ACTIVITY.

9a) DESCRIBE WATER ACTIVITY*

9b) WATER SAFETY LETTER*

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9c) CURRENT WATER SAFETY CREDENTIALS*

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Example American Red Cross Lifeguard Certification, PADI, ETC.

10) USE OF A BOAT?*

YES
NO

10 a) DESCRIPTION OF ACTIVITY - EXPLAIN WHERE BOAT WILL BE LAUNCHED FROM AND RETURNED TO.*

10 b) VALID CAPTAIN'S LICENSE OR BOAT SAFETY CARD - attach more than one if needed.*

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10 c) HA #s list more than one if needed. ----BOATS ONLY---*

10 d) BOAT REGISTRATION - attach more than one if needed.

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10 e) COAST GUARD BOAT- VESSEL NAME & OFFICIAL #

10 f) COAST GUARD CERTIFICATE OF DOCUMENTATION

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11) USE OF A THRILL CRAFT OR JET SKI?*

YES
NO

11 a) THRILL CRAFT OR JET SKIS = HA#*

HA#s - JETSKI OPERATOR NEEDS - THRILL CRAFT OPERATOR CERTIFICATE / DLNR BOAT SAFETY CARD & or CAPTAIN'S LICENSE - Please list more than one.

11 b) THRILL CRAFT OPERATOR CERTIFICATE / DLNR BOAT SAFETY CARD & CAPTAIN'S LICENSE - must have THRILL CRAFT credentials for each thrill craft used*

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11 c) THRILL CRAFT TOW IN SURFING?*

YES
NO

11 d) TOW IN THRILL CRAFT OPERATOR CREDENTIALS, THRILL CRAFT CREDENTIALS AND TRAILER CREDENTIALS.*

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12) USE OF A DRONE?*

YES
NO

12 a) DRONE - OPERATOR BEING HIRED AS A 3RD PARTY VENDOR?*

YES
NO

12 b) DRONE - PROOF OF CONTRACT BETWEEN APPLICANT AND DRONE COMPANY.*

12 c) - DRONE - (MAP) LOCATION - Google Satellite Map*

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GOOGLE SATELLITE IMAGE (Letter Size) 8.5 x 11. Detailed key of take off and landing area. Explain the highest height that will be reached during flight.

12 d) DRONE - 14 CFR PART 107*

FIRST & LAST NAME OF PILOT PILOT'S EMAIL ADDRESS PILOT'S PHONE NUMBER VISUAL OBSERVER FIRST AND LAST NAME

12 e) DRONE INFORMATION?*

MAKE AND MODEL OF AIRCRAFT SERIAL NUMBER CERTIFICATE NUMBER TOTAL PAYLOAD WEIGHT (INCLUDE UAS/CAMERA/ ADDITIONAL EQUIPMENT)

12 f) DRONE INFORMATION

Flight Time HOW ARE YOU RECOVERING DRONE HIGHEST HEIGHT FLOWN FROM GROUND

12 g) DRONE - CERTIFICATE OF INSURANCE -COI FOR UAS SYSTEM(S)?*

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$2,000,000 PER OCCURANCE FOR EACH UNMANNED AIRCRAFT SYSTEMS (UAS) SYSTEM SHOWING PROOF OF UAS COVERAGE FOR OWNED AND/OR NON-OWNED AIRCRAFT.

12 h) DRONE - FAA REGISTRATION*

12 i) DRONE - 14 CFR PART 107 License*

12 j) DRONE - UNMANNED AIRCRAFT SYSTEM COMPANY NAME?*

12 k) DRONE - CLASS OF AIRSPACE UAS ACTIVITY WILL OCCUR IN?*

REMINDER: IF FLYING IN CLASS B, C, D, OR E AIRSPACE, ATC AUTHORIZATION IS REQUIRED FOR ALL UAS ACTIVITY. https://faa.maps.arcgis.com/apps/webappviewer/index.html?id=9c2e4406710048e19806ebf6a06754ad

12 l) DRONE - WAIVERS- If you are requesting any of the following activities, please check all that apply and furnish proof of waiver from the FAA upon submission.*

Flying at night (§ 107.29)
Flying directly over a person or people (§ 107.39)
Third ChoiceFlying from a moving vehicle or aircraft, not in a sparsely populated area (§ 107.25)
Flying multiple aircraft with only one pilot (§ 107.35)
Flying beyond the pilot's visual line-of-sight (§ 107.31)
Flying above 400 feet (§ 107.51B)
Flying near airports / in controlled airspace (§ 107.41)

12 m) DRONE - WAIVERS : If you are requesting any of the above activities please attach all waivers.*

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12 n) DRONE - IMPORTANT PLEASE CHECK IF PROPERLY COMPLETED.*

UPLOAD - PART 107 DOCUMENTS
UPLOAD - FAA DRONE REGISTRATION
COMPANY NAME AND ADDRESS
$2,000,000 OCCURENCE FOR UAS DRONE (S)
DESCRIPTION OF OPERATION on COI - The State of Hawaii, including all departments and attached agencies, their officers, employees and agents are named as additional insured with respect to the named insured's filming activity.
CERTIFICATE HOLDER - CERTIFICATE HOLDER - State of Hawaii c/o State of Hawaii Film Office Dept. of Business, Economic Development & Tourism P.O. Box 2359 Honolulu, Hawaii 96804-2359
AUTHORIZED SIGNATURE

12 o) DRONE - OPERATOR UNDERSTANDS AND AGREES TO ABIDE BY ALL FEDERAL REGULATIONS UNDER THE FAA.*

I AGREE TO ABIDE BY THE FAA REQUIREMENTS.
I DO NOT AGREE TO ABIDE BY THE FAA REQUIREMENTS.

12 p) DRONE - Signature of DRONE OPERATOR or DRONE BUSINESS OWNER*

Participants electronic signature of an Award Agreement shall have the same validity and effect as a signature affixed by hand. Both production company and its Hawaii Representative or agent are responsible for the locations and activities listed herein.

12 q) DRONE COMPANY OWNER INFORMATION*

FIRST LAST EMAIL PHONE NUMBER

12 r) DRONE - UNMANNED AIRCRAFT SYSTEM COMPANY ADDRESS?*

ADDRESS CITY STATE/ PROVINCE ZIP / POSTAL CODE COUNTRY

13) APPLICANT NAME - name on insurance COI*

14) COI - LABEL - Ex. COMPANY NAME - Date 12-31-19*

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Required Wording: The State of Hawaii, including all of its departments and attached agencies, their officers, employees and agents are named as additional insured with respect to the named insured’s filming activities. General Liability - $1,000,000 Per Occurence $2,000,000 Aggregate Automobile Liability - $1,000,000 Bodily Injury (Per Person) $1,000,000 Bodily Injury (Per Accident) $1,000,000 Property Damage (Per Accident)

15) COI -CHECKLIST*

COMPANY NAME AND ADDRESS
$2,000,000 OCCURENCE FOR UAS
DESCRIPTION OF OPERATION on COI - The State of Hawaii, including all departments and attached agencies, their officers, employees and agents are named as additional insured with respect to the named insured's filming activity.
CERTIFICATE HOLDER - State of Hawaii c/o State of Hawaii Film Office Dept. of Business, Economic Development & Tourism P.O. Box 2359 Honolulu, Hawaii 96804-2359
AUTHORIZED SIGNATURE

16) Main Point of Contact - On location in Hawaii*

First Last

17) Email*

Additional Email

18) Phone #*

Website

https://

19) Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

20) APPLICANT HOLDER Signature*

Participants electronic signature of an Award Agreement shall have the same validity and effect as a signature affixed by hand. Both production company and its Hawaii Representative or agent are responsible for the locations and activities listed herein.

21) Format*

Still Photography
Video
Motion Picture Film (16-70 mm)

CHECK ALL THAT APPLY.

22) Project Type*

23) Project Budget - Dollar Amount*

24) Hawaii Expenditure - Dollar Amount*

25) Overall Budget - Dollar Amount*

26) Number of Local Hawaii Employees?*

27) Number of Out of State Employees?*

28) Number of Shoot Days*

29) Tax Credit Applicant?

Yes
No

30) ARE YOU REGISTERED TO DO BUSINESS IN THE STATE OF HAWAII?*

Yes
No

31) HAWAII GENERAL EXCISE TAX ID #*

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Film Permit Application

STANDARD FILM PERMIT (2)

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