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PERMIT/AGREEMENT <br />FOR A PROCESSION <br />l . Sponsor shall reimburse the Board for the actual cost to the City for the event, if deemed <br />necessary. <br />2. Sponsor shall provide to the Board a Certificate of Insurance showing a liability policy in <br />full force and effect with limits of $300,000.00 per occurrence and $5,000,000.00 <br />aggregate and the City of South Bend listed as an additional named insured for this event. <br />3. Sponsor shall provide to the Board all additional licenses, permits and documentation <br />required for the event. <br />4. Sponsor agrees to abide by all terms and conditions of the Board's policy governing <br />walks, runs, parades or other similar event adopted by the Board on March 3, 1985. <br />5. In order to ensure public safety during the event, the Board agrees to furnish traffic <br />planning, materials, equipment and personnel as deemed necessary by the Police <br />Department Traffic Bureau, the Bureau of Traffic and Lighting, and, where applicable, <br />the Board of Park Commissioners. <br />6. Sponsor acknowledges that the Police Department reserves the right to change this route <br />for safety purposes. <br />In consideration for approval by the Board and the use of the sidewalks for the purposes <br />set out above, the undersigned agrees and undertakes to hold the Civil City of South <br />Bend, Indiana, free and harmless from any liability loss, costs, costs, damages or <br />expenses, including attorney fees, which the Civil City of South Bend may suffer or <br />incur, as a result of any claims or actions which may be made by any person, including a <br />participant in said activity, arising out of the approval of the request to use the sidewalks <br />indicated in the City of South Bend. The undersigned certifies that he/she is authorized to <br />bind the above mentioned sponsor to the terms hereof. <br />8. Notification of approval4denial of this request will be issued by return of this form, upon <br />signed authorization by the Board of Public Works <br />I understand the above rules and regulations and that this application may be denied based on <br />any false or incomplete information. <br />Sponsor Signature <br />Printed NameZ?ff S <br />Title z,_6 ir�ayL <br />/�� BOARD OF PUBLIC WORKS APPROVAL <br />Pre 'dent /�� b,�U! <br />Pre Member <br />lllo,3C, <br />Memb Member Dates <br />RETURN FORM TO: <br />Board of Public Works <br />1316 County -City Building <br />227 West Jefferson Boulevard <br />South Bend, IN 46601 <br />Phone: (574) 235-9251 • Fax: (574) 235-9171 • E-Mail: publicwks@southbendin.gov <br />