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PERMITIAGREEMENT <br />FOR A PROCESSION <br />1. 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 f mish 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 />7. 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. Not Heaton of approval/denial of dils request ►vill be issued by return of dih forme, upon <br />signed autleorization 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 Name .� D( en I %ax <br />Title <br />BOARD OF P LIC WORDS APPR( <br />M er <br />� Z <br />/ Member <br />rum <br />Member <br />1 o �% 7 <br />Date <br />RETURN FORM TO: <br />Board of Public Works <br />1316 County -City Building <br />227 west Jefferson Boulevard <br />Soutb Bend, IN 46601 <br />Phone: (574) 235-9251 s Fax: (574) 235-9171 o E-Mail; publicwks@southbondin.gov <br />southbendin.gov <br />2 <br />