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information. Application cannot be processed without a copy of this license. <br />12. APPLICANT agrees to indemnify, defend and hold harmless the Civil City of South Bend, <br />Indiana, from any liability, loss, costs, damages or expenses, including attorney fees, which. the <br />Civil City of South Bend, may suffer or incur as a result of any claims or actions which may be <br />made by any person, including a participant in the activity, arising out of the approval of this <br />request by the Board of Public Works to close a portion ofthe public fight -of -way for the event <br />described above. <br />I have read the Application and Permit and theAgreement for the "U'se of Right of -Way far Special <br />Events" and I understand and agree to the above rules and regulations. I also understand that this <br />application may be denied based on any false or incomplete information. <br />Dated this Z-11 _ day of 20 1 <br />APPLICANT Signature <br />BOARD OF PUBLIC WORKS APPROVAL <br />President- Me bet <br />em Member, <br />Member <br />770,'I r3 0_ t l <br />Date <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 0 Fax. (574) 235-9171 0 E-Mail: publicwks@southbendin.gov <br />