MOU - Assist with Costs for Staffing & Supplies for Day Warming Center - Our Lady of the Road

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REIMBURSEMENT REQUEST Pursuant to the Memorandum of Understanding, dated March 24, 2020 (the "MOU"), between the City of South Bend, Indiana (the "City"), acting by and through its Board of Public Works (the "BPW") and Our Lady of the Road Inc. ("Our Lady"), the City donated the Donation Amount (as defined in the MOU) to Our Lady to be used in furtherance and support of Our Lady's weather amnesty efforts. In accordance with the terms of the MOU, Our Lady hereby requests that the BPW Representative, acting by the authority granted in the MOU, approve the disbursement to Our Lady of ..............6_.....6 Dollars ($ _. _ .00) of the remainder of the Donation Amount to reimburse Our Lady for its expenditures evidenced by the documents attached hereto as 1� hibit 1 (the "Supporting Documents"). In submitting this request, Our Lady hereby warrants and agrees as follows: 1. Our Lady has incurred the following expenses, which are reflected in the Supporting Documents, solely for purposes of advancing Our Lady's weather amnesty efforts and not for advancing or facilitating Our Lady's religious activities or the religious activities of any other organization: 2. Our Lady waives and releases any and all present and future liabilities of and claims against the City, the BPW, or any of their respective officers, agents, employees, successors, or assigns (collectively, the "City Parties") related to or arising out of the donation of the City Funds to Our Lady or Our Lady's use of the City Funds. Our Lady agrees to indemnify and hold the City Parties harmless from any liability, loss, costs, damages, or expenses, including attorneys' fees, which the City Parties may suffer or incur as a result of any claims or actions brought by any person or entity arising out of the donation of the City Funds to Our Lady or the use, occupancy, or condition of any real or personal property acquired by Our Lady using the City Funds. If any such claim or action is brought against any of the City Parties, Our Lady will defend such action or proceedings at its own expense and pay any judgment rendered therein. The undersigned represents and warrants that he or she is duly authorized to execute this instrument on Our Lady's behalf and to bind Our Lady to its terms. Further, the undersigned affirms, under penalties of perjury, that the statements contained in this instrument are true and accurate. OUR LADY OF THE ROAD INC., an Indiana non-profit corporation By: Printed: Its: Date: