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• City of South Bend Special Events Committee <br />Indemnity & Hold Harmless Agreement <br />Date: u Event Date: JaW �a <br />Event Name: �pt?PX c5� gAoCk— 90elro <br />Organization: <br />Applicant (Contact) Name: WQU caM l,o s ke <br />Applicant(Contact)Phone: L-7q-11t4f7 -056Y Alt. Phone: <br />Email: <br />77 <br />Address: l/69 8/0r.Cef es City/State/ZIP: <br />Event Location (Please describe): <br />jbwv S)-- A.'e4u.een <br />Length of Event (Dates/Times): <br />12u�le�:i qnd h1106Y4' <br />S aM - P:� P <br />I <br />APPLICANT agrees to indemnify, defend and hold harmless the Civil City of South Bend, Indiana, from any <br />liability, loss, costs, damages or expenses, including attorney fees, which the Civil City of South Bend, may suffer <br />or incur as a result of any claims or actions which may be made against the City, its agents, employees, or <br />subdivisions by any person, including a participant in the activity, arising out of the approval of this request by <br />the Civil City of South Bend, Indiana, through the Board of Public Works, to close a portion of the public right-of- <br />way for the event described above, or for any harm or damage alleged to have occurred because of the holding <br />of the special event. The undersigned certifies that he/she is authorized to bind the APPLICANT to these terms. <br />Signed on this Date: <br />Authorized Organizer <br />W <br />Printed Name and Title <br />• <br />