ࡱ> HJGQ bjbj++ 7DIoeIoen n 8,"*p'777"4 @!!!!!!!$2$&!HHH!77!Hd77!H!G  7pXz']L_ s!!0"g ,~'~' ~' HHHHHHH!!HHH"HHHH~'HHHHHHHHHn y:  UW Off-Campus Insurance for Student Filming THIS IS A TWO-WEEK PROCESS Students in the Department of Theatre and Film at the University of 91ȫܰ who are requesting to film at a location that requires insurance coverage can receive limited coverage through the University of 91ȫܰ. This includes public property such as streets, sidewalks, parks or public facilities (community centres, libraries etc which may also require production registration and permits through the City. ( HYPERLINK "https://legacy.winnipeg.ca/filmandspecialevents/FilmOffice/default.stm" https://legacy.winnipeg.ca/filmandspecialevents/FilmOffice/default.stm) Procedure Confirm you are familiar with all the steps on the Off-Campus Location Filming Checklist. Fill in this form via computer, save it, and email it as a Word attachment to the Risk Management department at  HYPERLINK "mailto:rms@uwinnipeg.ca" rms@uwinnipeg.ca, and cc the THFM Dept Office at  HYPERLINK "mailto:m.tallin@uwinnipeg.ca" m.tallin@uwinnipeg.ca. If you prefer, you may print the form, fill out the information (please write legibly), and return it to Ruth Damphouse, Risk Management and Insurance, 491Portage Avenue, Suite 5-4, and take a copy to the THFM Department Office, 3T03. Fill in ALL information. Allow at least 2 weeks for processing. The insurance certificate will be forwarded to the locations contact person via email (only if email is provided). Copies of the certificate will also be sent via email to the applicant and Melinda Tallin in the Department of Theatre and Film ( HYPERLINK "mailto:m.tallin@uwinnipeg.ca" m.tallin@uwinnipeg.ca). Date: Student Information Name Student # Phone Email Course Instructor Location Contact information Organization name Location Address (City) (Province) (Postal Code) Contact Person (Name and Title) Phone Number Email Fax Number (if applicable) Activity Information Describe the activity: What are the dates of the activity (to go on the Certificate)? What date is the certificate required by property owner/City of 91ȫܰ? Who is performing the activity? List the names of all paid or volunteer participants, excluding yourself (use extra space if required): 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Equipment Have you rented equipment from a source other than UW? (Yes (No If yes, from what vendor? Did you purchase property damage insurance from the vendor for rented equipment? (Yes (No Have you borrowed equipment from a source other than UW? (Yes (No If yes, provide name and contact information: Insurance Required Do they require proof of General Liability insurance? 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