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What follows is an unformatted view of the contents of the application form for indemnification. To apply for indemnification, you must download and complete the actual PDF application form, and then forward it to:
Canada Travelling Exhibitions Indemnification Program
Heritage Policy Branch
Department of Canadian Heritage
3rd Floor, 15 Eddy Street
Gatineau, Québec
K1A 0M5
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1. General Information |
| 1.1a |
Name and address of applicant institution
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| 1.1b |
Name, telephone number, fax number, and e-mail address of Director of institution
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| 1.1.b.i |
Preferred language for correspondence: |
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English
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French |
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| 1.1c |
Name, telephone number, fax number, and e-mail address of other contact person
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| 1.1.c.i |
Preferred language for correspondence: |
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English
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French |
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| 1.2 |
Title of exhibition
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| 1.3 |
Project Director
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Preferred language for correspondence: |
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English
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French |
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NOTE: Attach Curriculum Vitae
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| 1.4 |
Schedule of exhibition |
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location |
begin |
end
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| 1.5a |
Date and place for indemnity to begin
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| 1.5b |
Date and place for indemnity to end
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| 1.6 |
Abstract or summary of the theme/story line of the exhibition
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Objects and Appurtenances |
| 1.7 |
Description and ownership of objects and appurtenances borrowed from institutions and individuals inside Canada for which indemnity is requested (use format attached)
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| 1.8 |
Total fair market value of objects and appurtenances in the exhibition borrowed from inside Canada $____________CDN
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| 1.9 |
Description and ownership of objects and appurtenances borrowed from outside Canada for which indemnity is requested (use format attached)
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| 1.10 |
Total fair market value of objects and appurtenances in the exhibition borrowed from outside Canada $____________CDN
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| 1.11 |
Total fair market value of all objects and appurtenances for which indemnity is requested $____________CDN
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| 1.12 |
Description and ownership of objects and appurtenances for which indemnity is NOT requested (use format attached)
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| 1.13 |
Total fair market value of all objects and appurtenances in the exhibition $____________CDN
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Insurance |
| 1.14 |
On a separate sheet, describe any other insurance or indemnification coverage
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| 1.15 |
Has loss or damage over $5,000 involving an object or appurtenance occurred at the premises of any of the proposed host institutions or storage facilities in the past three years? If yes, provide details on a separate sheet.
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2. Assessment Criteria |
| 2.1 |
On a seperate sheet, explain the significance of the theme and contents of the exhibition in which indemnified objects and appurtenances will appear
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Transportation and Display |
| 2.2 |
Most recent date of approval of the Facilities Report for each proposed host institution |
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institution |
date
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| 2.3 |
On a separate sheet, describe packing, handling, shipping, and installation plans
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(a)packing specifications
(b)shipping and transportation arrangements
(c)special precautions
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| 2.4 |
On a separate sheet, describe any enhanced security measures
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| 2.5 |
On a separate sheet, describe any special environmental control arrangements
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(a)environmental controls
(b)special precautions
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| 2.6 |
On a separate sheet, describe measures to maximize public awareness of and access to the exhibition
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3. Other Information |
| 3.1 |
On a separate sheet, provide other relevant information
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| 3.2 |
On a separate sheet, describe other applications for financial support from the Department of Canadian Heritage
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4. Declaration |
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All information contained in this application, including all attachments and supporting material, is accurate and complete, and the valuations for the objects and appurtenances for which indemnity is requested are accurate and represent current fair market values to the best of my (our) knowledge. I understand that the information provided in this application is covered under the Access to Information Act and the Privacy Act.
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Director of Institution:Name and title (printed) |
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Signature |
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Area code and telephone number |
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Area code and fax number |
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Date |
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