Laserfiche WebLink
Sectio -E- Indemnity & Hold Harmless Agreement <br />City of South Bend Special Events Committee <br />Indemnity & Hold Harmless Agreement <br />Date: ����� , i Event Date: <br />' - -Ci J_� �I------------- <br />Event Name: 1�_i I_a_QL�Y ft+-----Y--41t'r Y__l _\ <br />Organization: I ___.............. ------------`---------------------------- <br />Applicant(Contact)Name:4L��� �Q\+�'.� <br />I / <br />Applicant (Contact) Phone: J :�'____ Alt. Phone: <br />Email: i '\ Q�C� Yll �Yl CL CF�YYI('�1:11 f ?1� 1 <br />Address: i_� ill, City/State/ZIP: <br />Event Location (Please describe): <br />�wccluc�hc�1 �ni-4,q pnnninj pcP'C)r+I4iDm <br />Length of Event (Dates/Times): ___W iG -12-1 m - IcpYYI <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: <br />Ver <br />Organizer Signature <br />---------- <br />Printed Name and Title <br />