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-om: Thomas Story Fax: (866) 610-8379 To: <br />Fax: (574) 235-9171 Page 3 of 3 0612312017 3:07 PM <br />PERMIT/AGREEMENT <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 terns and conditions of the Board's policy governing walks, <br />runs, parades or other similar event adopted by the Hoard on March 3, 1985. <br />5. In order to ensure public safety during the event, the Board agrees to furnish traffic <br />planning, materials, er:luipnient and personnel as deemed necessary by the Police <br />Department Traffic Bureau, the Bureau of Traffic and Lighting, and, where applicable, the <br />Board of Park Commissioners. <br />6. Sponsor acknowledges that the Police Department reserves the right to change this route <br />for safety pill -poses, <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 Bend, <br />Indiana, fee and harmless from any liability loss, costs, costs, damages or expenses, <br />including attorney fees, which the Civil City of South fiend may suffer or incur, as a result <br />of any claims or actions which may be made by any person, including a participant in said <br />activity, arising out of the approval of the request to use the sidewalks indicated in the City <br />of South Bend. The undersigned certifies that helshe is authorized to mind the above <br />mentioned sponsor to the terms hereof. <br />S. Notification of approvalklenial of this request ivill he issued fly return of this form, upon signed <br />authorization by the Board of'Puhlic 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 />p�_ <br />Printed Name <br />Title <br />OAR D OF' P BLIG W( <br />/"mn J, bu <br />President Member <br />Melter --- Member <br />APPROVAL <br />Member - - <br />`r S17 <br />Date <br />RETURN rot7,vt To: <br />Bwrd of Public Works <br />1316 County -City Buildirig <br />227 WC.0 Jeff rscni Soule-vaird <br />South fiend, 1N 46601 <br />Plione: (574) 235-9251 n Rik! (574) 235 9171 a -Mani: public-,Yksfc,�sotltftbendin.gov <br />2 <br />