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Sep, 16, 2016 2:48PM No. 0186 P, 4 PERMIT/AGREEMENT FOR A PROCESSION 1. Sponsor shall reimburse the Board for the actual cost to the City for the event, if deemed necessary. 2. Sponsor shall provide to the Board a Certificate of Insurance showing a liability policy in full force and effect with limits of $300,000.00 per occurrence and $5,000,000.00 aggregate and listing the City of South Bend as an additional named insured for the event, no less than two (2) weeks prior to the date of the event. 3. Sponsor shall provide to the Board copies of all licenses, permits, route maps, event flyers, description of event, and any other documentation required, with this application. 4. Sponsor agrees to abide by all terms and conditions of Resolution No. 9-1985, Establishing Policies and Fees for Foot Races and Similar Events, adopted by the Board of Works on March 4, 1985. 5. In order to ensure public safety during the event, the Board agrees to furnish traffic planning, materials, equipment and personnel as deemed necessary by the Police Department Traffic Bureau, the Bureau of Traffic and Lighting, and, where applicable, the Board of Park Commissioners. 6. Sponsor aclmowledges that the Police Department reserves the right to change this route for safety purposes. 7, In consideration for approval by the Board and the use of the public right-of-way for the purposes set out above, the undersigned agrees and undertakes to hold the Civil City of South Bend, Indiana, free and harmless from any liability loss, costs, damages or expenses, including attorney fees, which the Civil City of South Bend may suffer or incur, as a result of any claims or actions which may be made by any person, including a participant in said activity, arising out of the approval of the request to use the public right-of-way indicated in the City of South Bend. Thp undersigned certifies that he/she is authorized to bind the above mentioned sponsor to the terms hereof. 8. Notification of approval✓denial of this request will be issued by return of this form, upon signed authorization by the Board of Public Works I understand the above rules and regulations and that this application may be denied based on any false or incomplete information. Sponsor Signature Printed Name Title b� IJ. (rI la -Pevelsome4 BOARD 6F PUBLIC WO S APPROVAL President Mem er Member My niber��' Iv ember Dater YY RETURN FORM TO: 3 Board of Public Works 1316 County -City Building 227 West Jefferson Boulevard South Bend, IN 46601 Phone: (574) 235.9251 • Fax: (574) 235-9171 • &Mail: publicwksasout endin toy