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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: *)—I C)%z3 Event Date: 1 <br />Event Name: K c kC e- Rj JS:('t O �� \'V O � 1 <br />Organization: n k-1 V rC M C C�n.�vGk <br />Applicant(Contact)Name: L`O M45 <br />Applicant <br />AA(Contact)Phone: C-i7LO ��i�o—�,C73T Alt Phone: C� 6�1 `� -6 Z-- 4�i�� <br />Email: 7S W I('tO AAC A S� CAD d a"t+' Nam" -- <br />Address: kkf`A�-e! JA 0City/State2lP:�Jet^A <br />Event Location (Please describe): <br />Length of Event (Dates/Times): 9. — , 2— (`I,2023/q eLwx — JL ' 30 -L ✓L <br />Insurance Amount: This event is insured for no less than $700,000 per occurrence and $1,000,000 in aggregate, <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 />00 tri.t• kAA& Cat vt. 7 (a1 NdFve 67ti `^c Ptuc 5 lei sit L6G (! <br />Organization Name: 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 />0 Printed Name and Title <br />