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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: � 1d3 Event Date: <br />Event Name: <br />Organization <br />Applicant (Cc <br />Applicant (Contact) Phone: E717 - c;2YE< - ✓ - 09 Alt. Phone: 7 7y- �3'Z/— D OL/� <br />Email: I U / e tf 'vCarh> (ft) 3t-6ldq / tW,-t t. oo/• Or-V <br />Address: 250 5' UjG/-Q C1 S t City/State/ZIP: _s <br />Event Location (Please describe): <br />0k^ ro(4n,)S Cat- St, /4cLa�t <br />Length of Event (Dates/Times): <br />n� A9'L <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: St' 4ctcf /'"1. Par 1_r^ agrees to indemnifv. 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 approvatofthis 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 theAPPLICANT to these terms. <br />Signed on this Date: i /23 <br />/ !:'t <br />Authorized WI-3 fizer Signature <br />Printed Name and Title <br />