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Section E - Indemnity & Hold Harmless Agreement <br />City of South Bend Special Events Committee <br />Indemnity & Hold Harmless Agreement <br />Date: _�1 j12—I_ Event Date: tj`S I 12—' <br />Event Name: <br />Organization: <br />Applicant (Contact) Name:��L'tL _weaveV ----- -- <br />Applicant (Contact) Phone: - <br />hone: _ g=1%, OL0 !2 -__ Alt. Phone: <br />Email: L0Ve td t \a h '(D 0 P) 1/1n 0/1 r4 . V1 e — <br />Address: ACity/State/ZIP:—Li��O�S <br />Event Location (Please describe): <br />mol W cry n e St- SPS / <br />Length of Event (Dates/Times): —__l I b-1_ z p rvi — & <br />APPLICANT agrees to indemnify, defend and hold harmless the Civil City of South Bend, Indiana, from any <br />liability, loss, costs, damages or expenses, including attorney fees, which the Civil City of South Bend, may suffer <br />or incur as a result of any claims or actions which may be made against the City, its agents, employees, or <br />subdivisions by any person, including a participant in the activity, arising out of the approval of this request by <br />the Civil City of South Bend, Indiana, through the Board of Public Works, to close a portion of the public right-of- <br />way for the event described above, or for any harm or damage alleged to have occurred because of the holding <br />of the special event. The undersigned certifies that he/she is authorized to bind the APPLICANT to these terms. <br />Signed on this Date: Lo l q -1Z 1 <br />Signature <br />Printed Name and Title <br />