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E <br />C1 <br />City of South Bend Special Events Committee <br />Indemnity & Hold Harmless Agreement <br />Date: li / V'7 Event Date: 0 ar- f 1-Z3 <br />Event Name: Ic�l�"1 !/� sAe Li'j1,&j - A) <br />Organization: k12ig�+ <br />Applicant (Contact) Name: <br />Applicant (Contact) Phone: <br />Email: <br />Address: 470 N• 5*' <br />Event Location (Please describe): <br />y 334-'��3y Alt. Phone: <br />Length of Event (Dates/Times): <br />3 v-,eAkJoL-)f 1 /oe». - / t f .. <br />D7-1.GCG� <br />City/State/ZIP: J 8. -1A) LIU/ t <br />I9, 2e23 — 5-64 -" <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: & -A," Zy�3 <br />Organizer <br />rl56e ' f <br />Printed Name and Title <br />0 <br />