Request for Permission to Use Pictures, Photographs, Infographics, Maps and other Media For Publication

Requestor Information:

The pictures, photographs, infographics, maps and other media held by the Arizona Department of Water Resources (“Department”) contain material which were 1) created by the Department and are public records, or 2) are in private collections and are subject to copyright laws. See A.R.S. § 39-121.03 for commercial use of public records.

Organization/Company (If Applicable)

Representative *

Representative E-mail Address *

Address *

Representative Phone Number *

City *

State *

Zip Code *

Permission:

All requests to reproduce pictures, photographs, infographics, maps or other media from the Department must be submitted on this request form. The requestor agrees to abide by all terms, conditions and provisions of this request form.

Permission for reproduction is granted only when this request form is countersigned by an authorized representative of the Department. Permission for reproduction is limited to the

requestor and is non-transferable and only for the expressed purpose described in this request form. This permission is non-exclusive; the Department reserves the right to reproduce requested pictures, photographs, infographics, maps or other media, and to allow others to reproduce requested pictures, photographs, infographic, maps or other media.

The Department reserves the right to limit reproduction of its pictures, photographs, infographics, maps or other media and to impose such conditions as is required by donor agreement or law, or if original material is too fragile for reproduction.

_{Other media includes, but is not limited to, video and audio recordings.}

Description of this Publishing Project:

Author(s)/Creator(s) *

Title

Description

Place of Publication *

Publisher/Sponsor: *

Date of Publication *

Month

Day

Year

Economic classification of this publication:

Econ select list *

Publication by an accredited, non-profit organization [501(c)(3)]

Publication by a university or educational institution

Journal/Magazine Publication

Broadcast media

Book publication

For profit design or advertising use

Newspaper

Other

Powerpoint or Web (Note: 150 dpi with a title bar)

Title

Circulation

Audience

Production Run

End Product

Newpaper Title

Please describe

Reproduction of requested pictures, photographs, infographics, maps or other media: pictures, photographs, infographic, maps or other media supplied by the Department may not be copied, scanned, exhibited, resold, or used for any purpose other than that specified in this request form. The Department reserves the right to demand surrender of all materials containing unauthorized reproductions.

Copyright:

A. Copyright Warning:

WARNING CONCERNING COPYRIGHT RESTRICTIONS:

The copyright law of the United States (Title 17 U.S.C.) governs the making of photocopies or other reproductions of copyrighted material. Under certain conditions specified in the law, archives and libraries are authorized to furnish a photocopy or reproduction. One of these specified conditions is that the photocopy or reproduction is not to be "used for any purpose other than private study, scholarship or research." If a user makes a request for, or later uses, a photocopy or reproduction for purposes in excess of "fair use," that user may be liable for copyright infringement. The Department reserves the right to refuse a copying order if, in its judgment, fulfillment of the order would violate copyright law.

B. Permission:

In addition to the permission of the Department, additional permissions may be required as described below.

C. Privacy:

An individual depicted in a reproduction may have privacy rights under applicable law. The Department reserves the right to require a release from individuals whose privacy may be violated by the publication of this image.

D. Owner of original image:

In instances where the Department holds only a reproduction of an image, written permission of the owner of the image is required. The Department cannot grant permission or issue a print when the owner of the original image is known.

It is the responsibility of the requestor to obtain permission to publish reproductions from the owner of copyright (the institution, the creator of the record, the author, or his/her transferees, heirs, legatees, or literary executors). The Department will aid the requestor in contacting individuals by providing addresses, when available. However, the Department does not warranty the accuracy of that information, and shall not be responsible for any inaccurate information.

Acknowledgement *

I accept, personally and/or on behalf of the requesting entity, all of the conditions set forth above.

Hold Harmless and Indemnification:

The Department assumes no responsibility for violation of copyright laws, invasion of privacy, or any other improper or illegal use that may arise from reproduction of any image. The requestor agrees to hold the Department and its agents harmless against any and all claims arising or resulting from the use of each image and shall indemnify the Department and its agents for any and all costs and any damages arising or resulting from any such use.

Image Alterration *

I understand that the pictures, photographs, infographic, maps or other media must be reproduced unaltered and in their entirety unless approved in writing by the Department (standard cropping and resizing are permissible).

Credit line *

It is mandatory that a credit line, including image name or description and location (Active Management Area, Basin, etc.), appear with the image or on a credit page, indicating the page number. Crediting of each individual item is mandatory in all cases. Example: “Land subsidence in the Willcox Basin” by Arizona Department of Water Resources is licensed under CC BY-ND 4.0. The payment of a fee does not exempt a requestor from credit line requirements.

Pre-publication rights *

The Department reserves the right to examine proofs and captions for accuracy and sensitivity prior to publication with the right to revise if necessary. The Department reserves the right to refuse any request and to impose such conditions as it may deem in its best interests.

Payment of fees *

Prepayment of all fees is required before permission to publish is granted. Default in payment shall immediately revoke permission. If the size of edition or number of editions exceeds the terms specified in this request form, the requestor shall immediately pay the difference in use fees.

Final publication *

Upon the date of publication, the requestor agrees to send the Department one complete, best edition, gratis copy of the work containing the reproduction at no charge.

Original Prints *

All original prints are retained by the Arizona Department of Water Resources and do not leave the Department. Images may not be copied by a requestor using their own equipment.

Image Charges

Digital files (may be sent via email)	$12 plus any necessary scanning costs.
CD	$5 plus any necessary scanning costs.
DVD	$10 per DVD plus any necessary scanning costs
USB	$10 per USB plus any necessary scanning costs

Negative charge is an additional $15 per image. Please verify if a negative is required. Large/oversized items may require more than one scan. These charges are in addition to applicable use fees. Pursuant to A.R.S § 39-121.03(A)(3) The table below provides the cost of the reproduction on the commercial market as best determined by the Department.

Pursuant to A.R.S § 39-121.03(A)(3) The table below provides the cost of the reproduction on the commercial market as best determined by the Department.

Use Fee for Commercial Entities in addition to the image/infographic/map fees listed:

	Cost Per Photo/Inforgraphic/Map
Periodicals/Serials
Under 20,000 circulation	$20.00
20,000 to 49,999	$40.00
50,000 to 99,999	$75.00
over 100,000	$100.00
Book Editions
Under 10,000 copies	$20.00
10,000 to 24,999 copiess	$50.00
25,000 to 49,999	$85.00
over 50,000 copies	$100.00
Book jacket	$150.00
Advertising and promotional uses (such as postcards, menus, note paper, unbound materials, posters, brochures, etc.)
Arizona	$75.00
Regional	$150.00
National	$250.00
Worldwide	$450.00
Broadcast film, television or newspaper
Arizona	$20.00
National	$100.00
Worldwide	$250.00

Nonprofit Entities, 501(C)(3): A fee of $10 is charged for one time, one edition use of a pictorial image by nonprofit entities that have 501(c)(3) status; multiple use of a pictorial image by a nonprofit entity is subject to the fees outlined in the use fees for Commercial Entities.

Image Request

Request to reproduce pictorial images, infographics, or maps held by the Arizona Department of Water Resources. Payment must be made by cash, check or money order. Please remember you must pay both an image fee and a use fee.

Acknowledgement *

I accept, personally and/or on behalf of the requesting entity, all of the conditions set forth above.

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Request for Permission to Use Pictures, Photographs, Infographics, Maps and other Media For Publication