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Section K - Indemnity & Hold Harmless Agreement <br />• <br />• <br />Date: <br />Event Name: <br />City of South Bend Special Events Committee <br />Indemnity & Hold Harmless Agreement <br />Event Date: <br />rj <br />(a ///1a3 <br />Organization: 3& • <br />Applicant (Contact) Name: <br />^ P,ef <br />Applicant(Contact)Phone: 709 Alt. Phone: S7�/' 3 3y' 0OL/9 <br />Email: <br />se <br />Address:aSS 0W/ 6r,?ey Sf- City/State/ZIP: SoH� 9-erej 1i <br />&*t-4+n c� Sf - Ada '/6.oi-E M'-+S-Q <br />Event Location (Please describe): 1-kIevr St-) �o 'p�,/l/peA Se 7b J:�rPp S� <br />�o Wa/nL4,A St -)') DL4, aUt. St St <br />Length of Event (Dates/Times): G // l ! a 3 y ? . l S' <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: �G /7� q �7 Q�f f s� - �4 3 / n +i �bi+S 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 attorneyfees, 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: 3 L..?e3 <br />Authorized Wanizer Signature <br />• r• [A04M 7o5-A) <br />Printed Name and Title <br />