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PERM IT/A GR ETA EAT <br />FOR A PROCESSION <br />I. Sponsor shall reimburse the Board lot' the Actual cost to the City for the event, if'decolccl <br />necessary. <br />2. Sl,gllsor shall provide to tile: Botn•d a C ertificatr, of Insurance showing aliability policy in <br />Full 1i61•cc and effect will) limits of $3110,000.I)0 per oc:cuE"rcnce and $5,000,000.00 <br />, 'I g <br />Pgre-gate and ills C'ily of•Soufh Bend lived its till additional mulled insured fur this cvcnt. <br />3, Sponsor Shift provide to tile. Board till additional IiMINGS, pet-11AS arld (IUetllllcaltatioll <br />required Ior lllc twill, <br />4. Sponsor agrees to abide: by all terms and conditions of' the; Board's policy governing <br />Watlks, tuns, parades or otllcl• similar event adopted by the Board on March 3, 1985. <br />5. In order to ensure public Safety during the event, (lie Board agrees to fin•tlish traffic <br />pl;lliniM,I, materials, equipment and personnel as c,lccuic(1 nccessin•y by the Police <br />Department Traffic Bureau, tie: NIMUu of TI'[1111C allul Lighting, and, where applicable, <br />the Board of Park Commissiollcl:5. <br />6. Sponsor acknowledges. that the Police Department reserves the right to climige this route <br />for Safety purposes. <br />7. In consideration for approval by the Board 'ilnd the use of (lie sidewalks for the pllrl)OSCS <br />Set out above, (lie llnders'tgnccl agrccs and alndcrlakes to hold the Civil City of Soctlh <br />Bend, Indiana, free and harmless from any liability loss, costs, costs, damages or <br />expenses, ineluding nttorlicy tees, which the Civil City of South Bend may suffer or <br />illellr, as a result of any claitlls or actions which may be made by any pel•Son, including, a <br />participant in said activity, itt•isillg; out of the approval of the request to use t1w sidewalks <br />indicated in the City of South Bend. The undersigned certifies thttl he/she is au(hot'ilcd to <br />bind the above mentioned spoilsol, to the terms hcrcot'. <br />K. Not?flealiorr qfrrpprovrrUdeuiul uf MIS request hill he i'mut" l by relrrrvt o% tins furor, upon <br />signed lruffie r'!x(rliim i/V Me Bourdof'Public TI/o ks <br />I ulldel'stand the above retleS and regulations and that this application may be denied based clll <br />any false or incomplete information. <br />Sponsor Signature <br />Printed Natue <br />Title.}n� rtr�u•n-i- <br />%� 13 )l1RD ()1�� PUBLIC 1� WORKS AxP&;VAL <br />4 <br />I'resi(IC1-1 Wier Member <br />MRETURN FORMTO, <br />euahcr�' Mct ter )ntc <br />G <br />Ilumd url'ublic !Yorks <br />1316 a omily-City BoIlding <br />227 wost .Icllciso) llmlll'Vafd <br />5uw11 Bend, 1N 4660I <br />111lonc: (574) 235-9251 Fwc (57,1) 215-9171 w lI.-ivinil; putrlicwks(rQsuulhhcltdil7,gnv <br />