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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: _:, =0?3 //// Event Date:.�ire <br />Event Name: �e'Vyv- F4/'i /rAA /-1- lr-4-1�,- <br />Organization �f n/LI����Y�i^�o�/ <br />Applicant (Contact) Name: hLrV 25;P1101 <br />Applicant (Contact) Phone:Alt Phone: <br />Email: �ECJT /C//1G �� f/A7. eVIV <br />Address:&Iflai <br />Event Location (Please describe): <br />LeeO,-r ArlE <br />Length of Event (Dates[Times)r0i?e, 16 '''17 _ /06 , - lo�v,-I�-,6,- <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 />• <br />�1 / / (I <br />Organization Name: .Te / P 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]__ <br />Organizer Signature <br />Printed Name and Title <br />