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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: LI-12 -;2 3 <br />Event Date: 22- 7 — <br />Event Name: t_tg1lsL-----LLQ��_ yt3r�1�.�L—_1LiQe ......... <br />— <br />----- <br />Organization: <br />ns2%s—_!`1te! <br />Applicant (Contact) <br />Applicant(Contact)Phone: �__�Ol t- �iS 073 _AIt.Phone: <br />Email: Al 1jZpL rrL"_ _ <br />Address: Gos !�P._Aj- c , _ ........ City/State/ZIP: _ / 51f q w.� <br />Event Location (Please describe): <br />WAS- M140-- 3Z11ru*?'0 RD. So. 8 ")40 <br />Length of Event (Dates/Times): _-aIVF R.4. — <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: GR-� c ri — �, E r; i� r J —�j ------ 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 />Authorized Organizer Signature <br />• -�1'y %� _ -1�t�L.�-------------------------------- - - <br />- -- - ----- - --------- <br />Printed Name and Title <br />