Laserfiche WebLink
Section K - Indemnity & Hold Harmless Agreement <br />City of South Bend Special Events Committee <br />Indemnity & Hold Harmless Agreement <br />Date:, ��! � ���Event Date:_ <br />--------------- <br />Event Name: _ £�: -6Y2 ..rkj(�%v`�G� <br />Organization: -mss l! ,�_. tQ2 l_ Z a'2f <br />Applicant (Contact) Name:�'i2W��i L�)� LT�Rj�__ <br />Applicant (Contact) Phone: _L-,o,o Y. iS- C 915-- Alt. Phone: <br />Email: k 1 LT�k5� CrC -�------- --- --- <br />Address: _ -�cy,� sf_- '7 --___-- —_T City/State/ZIP: �lc7l� q-+-��i �Y-V <br />Event Location (Please describe): <br />Length of Event (Dates/Times): _ -", - T-- ,) j/ Qa__Pg��"^ <br />Insurance Amount: This event is insured for no less than $700,000 per occurrence and $1,000,000 in aggregate, <br />and the certificate of insurance includes a rider naming City of South Bend, Special Events Committee, and Board <br />of Public Works as additionally insured for the event. <br />Organization Name: � 1 C&iJ �rl agrees to indemnify, defend <br />and hold harmless the Civil City of South Bend, Indiana, from any liability, loss, costs, damages or expenses, <br />including attorney fees, which the Civil City of South Bend, Indiana, may suffer or incur as a result of any claims <br />or actions which may be made against the City, its agents, employees, or subdivisions by any person, including a <br />participant in the activity, arising out of the approval of this request by the Civil City of South Bend, Indiana, <br />through the Board of Public Works, to close a portion of the public right-of-way for the event described above, <br />or for any harm or damage alleged to have occurred because of the holding of the special event. The <br />undersigned certifies that he/she is authorized to bind the APPLICANT to these terms. <br />Signed on this Date: <br />--------------- <br />Authorized Organizer Signature <br />Printed Name and Title <br />