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Section E - Indemnity & Hold Harmless Agreement <br />City of South Bend Special Events Committee <br />Indemnity & Hold Harmless Agreement <br />i <br />Date: S ( D -I-,, 11 Event Date: / I <br />Event Name: <br />Organization: ) ) PSI JucE—o0a /CiGjt C �4 �Yy L <br />Applicant (Contact) Name: _! b N c' �IC�J <br />Applicant (Contact) Phone: Alt Phone: c <br />Email: t)odY�(�/ VVv( - 0 J <br />Address: City/State/ZIP: <br />Event Location (Please describe): 50 <br />R4. <br />Length of Event (Dates�mes):vv�.h 'J l .Pr M <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: / v Z <br />Authorized Organizer Signature . j 51t� j Z k LZ <br />�vh� M:orJCZU�Sk <br />Printed Name and Title <br />I Wwu w�2� <br />0 <br />[�Y�(ipi. ��td bOY��o� AS01,Lt(ik <br />