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City of South Bend Special Events Committee <br />Indemnity & Hold Harmless Agreement <br />Date: 11 Z O L i Event Date: TH I ZO 2 '� <br />Event Name: X <br />Organization. <br />Applicant (Cc <br />Applicant (Contact) Phone: � l )_� 1- (c I C l - Alt. Phone: _Z � 1 ( 1C• k R ` A (C c a- <br />Address:C�-�,3 i 1N ,\ -{., : —City/State/ZIP: �,,_ t �Js rA <br />Event Location (Please describe): <br />CIA- <br />�hc� G.N COS <br />Length of Event (Dates/Times): --,) <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: t G � '�' Ky- 2�v' C, (_n. < C 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: �1�J c';1 <br />Signature <br />Printed Name and Title <br />