Special Event - Scholarship Walk-A-Thon - September 18

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Section K - Indemnity & Hold Harmless Agreement Date: Event Name: Organization: Applicant (Contact) Name: ______ Applicant (Contact) Phone: ...... Email: Address: Event Location (Please describe): Length of Event (Dates/Times): City of South Bend Special Events Committee Indemnity & Hold Harmless Agreement Event Date: Alt. Phone: City/State/ZIP: Insurance Amount: This event is insured for no less than $700,000 per occurrence and $1,000,000 in aggregate, and the certificate of insurance includes a rider naming City of South Bend, Special Events Committee, and Board of Public Works as additionally insured for the event. Pentecostal Church Fine Arts Dept. Organization Name: ______ agrees to indemnify, defend and hold harmless the Civil City of South Bend, Indiana, from any liability, loss, costs, damages or expenses, including attorney fees, which the Civil City of South Bend, Indiana, may suffer or incur as a result of any claims or actions which may be made against the City, its agents, employees, or subdivisions by any person, including a participant in the activity, arising out of the approval of this request by the Civil City of South Bend, Indiana, through the Board of Public Works, to close a portion of the public right-of-way for the event described above, or for any harm or damage alleged to have occurred because of the holding of the special event. The undersigned certifies that he/she is authorized to bind the APPLICANT to these terms. Signed on this Date: August 24, 2021 Karen L. White Authorized Organizer Signature Karen L. White Printed Name and Title Digitally signed by Karen L. White Date: 2021.08.24 18:40:58 -04'00'