Laserfiche WebLink
Date: V — a <br />Event Nam <br />Organization: <br />Section E - Indemnf & Hold Harmaess AAMment <br />City of South Bend Special Events Committee <br />Indemnity & Hold Harmless Agreement <br />07'w a, <br />Applicant (Contact) Name: <br />Applicant (Contact) Phone: _9N act -�N —F6l V I r - -- <br />__ Alt. Phone: <br />Email: <br />Address: <br />Event Location (Please describeY <br />Length of Event (Dates/Times): <br />City/state/ZIP: <br />02 1 104m <br />APPLICANT agrees to indemnify, defend and hold hamdess 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 Worksto close a porton of the public right-of- <br />way for the event described above, or for any harm or damage alleged s, have occurred bemuse 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: _ ; f4 <br />Authorized Organizer Signature _ <br />Printed Name and Title <br />