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City of South Bend Special Events Committee <br />• Indemnity & Hold Harmless Agreement <br />Date: 7/IS12423 Event Date: IIioIZOZ3 <br />Event Name: Bloc_ k i <br />Organization: <br />Applicant (Contact) Name: ikW M h �i"J <br />Applicant (Contact) Phone: L Alt. Phone: <br />Email: k`,'��IA22t 364Mc 1 cc' ' <br />Address: I5-77 E (oW-xK fqT City/State/ZIP: -y3'j Tile 1L6 7 <br />Event Location (Please describe): <br />6 t'; k P'Ay bciv`ce ,. —� - yc k cr`► y Cn Co ialC <br />Length of Event (Dates/Times): <br />3 kcv5 (Li-7) 0A q/I0 <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: 7/19/ 0 Z 3 <br />Authorized Organizer Signature <br />Printed Name and Title <br />r 1 <br />LJ <br />