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City of South Bend Special Events Committee <br />• Indemnity & Hold Harmless Agreement <br />Date: ' - I W _ �' � Event Date: 7- y- of 3 <br />Event Name: LI T 14 O r f`11 Y r i g e W o R k S <br />Organization: N / <br />Applicant (Contact) Name: o 6 /y ig 01 go me I I N 5 <br />Applicant (Contact) Phone: (S-% -V) S z ' C 0.- 6 Alt. Phone: <br />Email ON A I d4T 7 /4 R ' e 0� <br />Address: � U� fi I e N i 7 City/State/ZIP: So 07 H D -ee j. <br />Event Location (Please describe): <br />0F����e1 <br />Length of Event (Dates/Times) <br />7_Ll-�3To7-1-/-23 8PMTOI,Z190 <br />• APPLICANT agrees to indemnify, defend and hold harmless the Civil City of South Bend, I ndiana, 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: S � 3o , � 3 <br />A o.,A 7w., <br />Authorized Organizer Signature <br />�QyJ�I <) td <br />Printed Name and Title <br />0 <br />