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Jan 221812:51p Fastsigns South Berm 6742640536 p,3 FERMIT AG11MEME'NI' FOR A. PROCESSION 1. Sponsor sliall xeirrrburse. the Board for the actual cost to the City for the event, if deetned necessary. 2. Sponsox shall provide to the Board a Certificate of Insurance showing a liability policy in full force and effect With limits of $300,000.00 per occurrence and $5,000,000,00 aggregate and the City of South bond listed as au additional named insured for this event. 3. Sponsor shalt provide to the Board all additional licenses, permits and documentation required for tiro event. 4. ff this event results in closure of a residential street, all residents within the affected area must be notified of this event, The APPLICANT must make a reasonable attempt to notify all residents that reside on the block. A copy of a birechure or letter desclriljug the event purpose, date, and time must be distributed to all affected neighboa�s and jucluded with the application. 5. If this cvellt results in closure of a residential street, the applicant is responsible, prior to the event, for deter-Aining if there are any residents affected that could potoutially need assistance in accessing their residence. The applicant is respongible for providing said reside) -kit access or transportation to their propeety_ 6. Sponsor agrees to abide by all terms and conditions of the Board's policy governing walks, runs, parades or other similar event adolited by the Board on March 3, 1995. 7, hi order to eztsure public safety during the event, the, Board agrees to fionush traffic planning, materials, equipment and personnel as deemed necessary by the Police Department: Traffic Bureau, the Bureau of Traffic and Lighting, and, where applicable, the Board of Park Corxmnissioners, 8, Sponsor aelmowledges that: the Police DepaTtMOnt reserves the right to change this xaute- for safety purposes. 9_ In consideration for approval by the Board and the use of the sidewatics for the purposes set: out above, the undersigned agrees and undertakes to hold the Civil City of Soutli Bend, Indiana, free and bartrtless from any liability loss, costs, Costa, damages or expenses, inchtding attorney fees, which the Civil City of South Bend may suffer or incirr, as a result of any claims or actions which inoy be made by any person, including a participant in said activity, arising out of the approval of the request to use the sidewalks indicated in the City of South Bend, The undersigned certif os that lie/she is authorized to bind the above mentioned sponsor to the terms hereof, 10. Notification of approvalJdenial of this regmst will be issued by return of this form, upon signed authorization by the Board of Public Works I understand the above rules and regulations and that this application may be decried based on any false or incomplete information, 4V a .A h 4L Spomor Signature It1 FURN FORM TO. - Board of Publie Worts 1316 County -City Building 227 'Nest Jefferson Boulevard Soulh.Send,1946601 Phone: (574) 235-9251 ■ Vax: (574) 235.9 [71