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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: _JZ ��C..... 7��Q Event/gate: <br />Event Name: <br />Organization: <br />Applicant (Contact) Name: _1��-I__/_1 _LSL_/1Cl�Li[I_C---------------------------------------------------- <br />Applicant (Contact) Phone: _ _ <br />ls7 _1 �7----------------- Alt. Phone: _ L_--��----------- <br />Email: <br />2.fn. <br />J --I-----,, - [� <br />Address: ___110''0_U)_5_t ------ City/State/ZIP: <br />Event Location (Please describe): <br />Length of Event (Dates/Times): __[ Y/- l ------ ! _-vo?%m- -�= �- ""--"--"- <br />////---- <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: _ 1 �e L __ - ➢t t%'1�� 1_ agrees to indemnify, defend <br />1J ----------- <br />and hold harmless the Civil City of South Bend, Indian ,from y 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 />Organizer Signature <br />ha <br />Printed Name and Title <br />