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Section K - Indemnity & Hold Harmless Agreement <br />City of South Bend Special Events Committee <br />Indemnity & Hold Harmless Agreement <br />Date: _ 6 �y Event Date: ---- <br />Event Name: Rg'n SK <br />Organization: <br />Applicant (Contact) Name: (/A✓�rti ___ _ <br />Applicant (Contact) Phone: _ 630 =6�" 6a3 �(— Alt. Phone: <br />Email: <br />Address: 3� f'%ru�- Sf___--City/State/ZIP: �o lit% 4`LG/y <br />Event Location (Please describe): <br />Length of Event (Dates/Times): a' 3G `� " �S`��""� i t o.'OV --SV4V.'Y(- 1/.'.To - e-,'( <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:—y—n(-t(�—( �Ct</K .n agrees to indemnify, defend <br />and hold harmless the Civil City oASouth 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 />Authorized CSrganizer Signature <br />Printed Name and Title <br />