PERMISSION, RELEASE AND INDEMNIFICATION AGREEMENT
We, ___________________________________________, (company or entity name) desire to utilize the public streets and sidewalks of the City of Portsmouth (the
City) while engaged in filmmaking in the City on ________ (dates) from ______a.m. to
_________p.m.
We, acknowledge that this activity is not sponsored by the City of Portsmouth.
We further acknowledge that the City of Portsmouth cannot and does not guarantee, insure or warrant that the premises in and along its streets and sidewalks, particularly its rights of way, to be free of holes, obstructions, or other dangerous conditions or objects.
Recognizing the potential dangers involved in the activity and in consideration for being allowed the right to enter onto City property for the activity, we, for ourselves, our employees, invitees, persons present, agents and personal representatives, assigns, heirs, and next of kin, voluntarily agree to assume all such risks and responsibility for loss, injury, costs and damages that we or they may incur as a result of the conditions either known or unknown of the premises. We furthermore, on behalf of ourselves, employees, invitees, persons present, agents and assigns release, discharge and covenant not to sue the City, its employees or agents as a result of any injuries or damages resulting from the condition(s) either known or unknown of the premises. We furthermore agree that if we or any of our agents, persons present, invitees, employees, present on our behalf or due to this activity make a claim against the City, its employees or agents, we will indemnify, save and hold harmless the City and its employees from any and all litigation, expenses, attorney fees, loss, liability, damage or costs which may be incurred as a result of such claim.

We agree to submit to the City prior to filming a certificate of public liability insurance with a limit of not less than $3,000,000 (three millions dollars), naming as an additional insured the City of Portsmouth, Virginia.
WE HAVE READ THIS AGREEMENT, FULLY UNDERSTAND ITS TERMS,
HAVE SIGNED IT FREELY AND INTEND IT TO BE A COMPLETE AND
UNCONDITIONAL RELEASE OF LIABILITY TO THE GREATEST EXTENT
ALLOWED BY LAW, AND AGREE THAT IF ANY PORTION OF THE
AGREEMENT IS HELD TO BE INVALID, THE BALANCE OF THE AGREEMENT
SHALL CONTINUE IN FULL FORCE AND EFFECT.
Company:__________________________________
___________________________________________
Signature of Authorized Representative
Address______________________________________
_____________________________________________
Phone No:_____________________________________
Notary Statement
State of Virginia
City of __________________ to wit:
The foregoing was acknowledged before me this ________ day of
____________, 20_____, by ____________________.
Notary Public _____________________
My Commission expires__________________