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Section K - Indemnity & Hold Harmless Agreement <br />• City of South Bend Special Events Committee <br />Indemnity & Hold Harmless Agreement <br />Date: 0/APG 2-3 Event Date: �IlltI23 <br />Event Name: �O�Cjt'g ' a4l aoz-a, <br />Organization: ptx.e f lard, Gdr a-yP <br />Applicant(Contact)Name: Q,.6�.�sa�, <br />Applicant(Contact)Phone: -ai-7- Q7ZN Alt. Phone: SV-sYO- 9&%C0 <br />Email: ,OLr oh/c/dt - 4M Qxra��•�M r <br />Address: l23 N Al A City/State/ZIP: j1;jA A!f&d, I;V ti�i nn <br />Event Location (Please describe): <br />Length of Event (Dates/Times): <br />Insurance Amount: This event is insured for no less than $700,000 per occurrence and $1,000,000 in aggregate, <br />• <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: —&r— (&r-4 Gcid W 'c)O 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 attorney fees, 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: && 2 J <br />Authorized Organizer Signature <br />Printed Name and Title <br />