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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: 11 �/lI Event Date: A I <br />Event Name: <br />Applicant (Contact) Name ` -,CA T 1 ([m rd <br />Applicant (Contact) Phone: S % 9 —QU — QZ',/ Alt Phone: d lC — 3 q `f —7r'1Q d <br />Email: <br />Address: i 10& A 1 l i—Ah S , d -Q Fjl i/CL City/State/ZIP: RO U I", '.S Q,Y..(1J-;�U <br />Event Location (Please describe): At 0 r v, S �-e mac: <br />44'ecry <br />d A- e 4-«oci - <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 adddionally insured for the event <br />Organization Name: LllorS a d 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 />Authorized Organizer Signature <br />rnnreu Name anu i me <br />