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REIMBURSEMENT REQUEST <br />Pursuant to the Memorandum of Understanding, dated November 12, 2019 (the <br />"MOU"), between the City of South Bend, Indiana (the "City"), acting by and through its Board <br />of Public Works (the "BPW") and The Center for the Homeless, Inc. ("CTFH"), the City donated <br />the Donation Amount (as defined in the MOU) to CTFH to be used in furtherance and support of <br />CTFH's weather amnesty efforts. In accordance with the terms of the MOU, CTFH hereby <br />requests that the BPW Representative, acting by the authority granted in the MOU, approve the <br />disbursement to CTFH of Dollars <br />( .00) of the remainder of the Donation Amount to reimburse CTFH for its <br />expenditures for the operating and/or staffing of its weather amnesty location evidenced by the <br />documents attached hereto as Exhibit I (the "Supporting Documents"). In submitting this <br />request, CTFH hereby warrants and agrees as follows: <br />1. CTFH has incurred the following expenses, which are reflected in the Supporting <br />Documents, solely for purposes of advancing CTFH's weather amnesty efforts and not for <br />advancing or facilitating religious activities: <br />2. CTFH waives and releases any and all present and future liabilities of and claims <br />against the City, the BPW, or any of their respective officers, agents, employees, <br />successors, or assigns (collectively, the "City Parties") related to or arising out of the <br />donation of the City's funds to CTFH or CTFH's use of the City's donated funds. CTFH <br />agrees to indemnify and hold the City Parties harmless from any liability, loss, costs, <br />damages, or expenses, including attorneys' fees, which the City Parties may suffer or <br />incur as a result of any claims or actions brought by any person or entity arising out of the <br />donation of the City's funds to CTFH or the use of the City's funds by CTFH. If any such <br />claim or action is brought against any of the City Parties, CTFH will defend such action <br />or proceedings at its own expense and pay any judgment rendered therein. <br />The undersigned represents and warrants that he or she is duly authorized to execute this <br />instrument on CTFH's behalf and to bind CTFH to its terms. Further, the undersigned affirms, <br />under penalties of perjury, that the statements contained in this instrument are true and accurate. <br />THE CENTER FOR THE HOMELESS, INC. <br />an Indiana non -piµ fit corporation <br />By: <br />Printed: <br />Its: <br />Date: <br />