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REVOCABLE PERMIT <br />RECOGNITION OF ENCROACHMENT UPON CITY OF SOUTH BEND-CONTROLLED PROPERTY <br />AND PROVISIONS ALLOWING TEMPORARY CONTINUANCE OF SAME <br />Company/Homeowner Name _____________________________________________ , hereafter, the “APPLICANT.” <br />The encroachment will be permitted to remain and continue under the following terms and conditions: <br />1)Until such time as the BOARD OF PUBLIC WORKS (“BOARD”) of the CITY OF SOUTH BEND (“CITY”) shall <br />determine that such encroachment is in any way impairing or interfering with the highway or with the free and <br />safe flow of traffic thereon; <br />2)Said encroachment shall not in any way prejudice or preclude the CITY’S rights with respect to the future use of <br />the portion of the right-of-way; <br />3)The encroachment as it now exists shall in no manner be added to or enlarged in its present scope or dimensions; <br />4)In the event of change of ownership of the fixture or any other item of personal property which constitutes the <br />aforesaid encroachment, this permit shall become null and void; <br />5)The CITY shall not be liable to APPLICANT for any damages caused to APPLICANT that arise out of or is incidental <br />to any activity and/or incidences authorized by this permit; <br />6)In consideration of the granting of this Permit by the BOARD, APPLICANT shall indemnify, hold harmless and <br />defend the CITY from and against any and all actions or causes of action which the CITY may suffer or incur by <br />reason of bodily injury, including death, to any person or persons, or by reason of damage to or destruction of any <br />property, including the loss thereof, arising out of or in any manner connected with any activity and/or incidences <br />authorized by this permit and/or any activities and/or incidences incidental thereto, or which the CITY may <br />sustain or incur in connection with any litigation, investigation, or other expenditures incidental thereto, including <br />any suit instituted by the CITY to enforce the obligation of this agreement of indemnity. <br />It is the intent of the parties hereto that the APPLICANT shall indemnify the CITY under this indemnification <br />clause to the fullest extent permitted by law. <br />This approval shall be binding upon everyone past or present, claiming any interest in and to the aforementioned <br />encroachment. <br />ACCEPTANCE OF TERMS AND CONDITIONS <br />I accept and agree to be bound by all of the terms and conditions of this permit. <br />Submitted By: <br />Signature: <br />Date: <br />President <br />Member <br />Member <br />Member <br />Member <br />Attest <br />Revised on 9.14.21 <br />November 23, 2021