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• Section E - Indemnity 6 Hold Harmless Agreement <br />City of South Bend Special Events Committee <br />Indemnity 6 Hold Harmless Agreement <br />Date: 0-1 " t cl - Z 3 Event Date: (DO - C( - Z 3 <br />Event Name: 11W Tj\'QTN T)4 `, <br />Organization: <br />Applicant (Contact) Name: \_� 'T k U P, S to 0 t2Qk 5 <br />Applicant (Contact) Phone: Lk u b R1 i_ (a Ln q 9 Alt. Phone: <br />Email: , eta� \ n, t, - 2 7 9 hv-�Cc \ f_b M <br />Address: -L2 Gm :&Z_ 13 City/State/ZIP: <br />Event Location (Please describe): A le (o \ <br />Length of Event (Dates/Times): Occ)_� - 1 c\ - Z :!� `- - 1 t-'� q "� Vk <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 Da jo�/9 <br />Authorized Organizer Signature <br />�� % � ck A �'k C) Q Lk S <br />Printed Name and Title <br />