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City of South Bend Special Events Committee <br />. Indemnity & Hold Harmless Agreement <br />Date: <br />Event Name: <br />Organization: 1 / <br />Applicant (Contact) Name:VfJ7�`f <br />Applicant (Contact) Phoneme I �:l Q / Alt. Phone: <br />Email: UlU/UUV,^Vl(14.L-k-)Q W)LIlUQ�- {0E'_J <br />w " <br />Address: 1 101 �a v.)eV� City/State/ZIP: lJ 14y1 <br />Event Location (Please describe): <br />Length of Event (Dates/Times): <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 />Printed Name and Title <br />C � J <br />