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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 ______________ Event <br />Event Name: 1_�Vy_Y �l�C1J ►} 1__ _! w! ` '�___ _ <br />Organization: _- -OxAjt 1-& ----- �1} I �1 hS_��h l----------------------------- <br />Applicant (Contact) Name: —��-k-1�p�>15 L-1-liclil- <br />-- -OxAjtl-&X� (Contact) Phone:0q _Y3 =51 00 Alt. Phone: <br />Email: S I (� rda n I�1155 bu,S . to � n _u-5 ------ ------------------- / 4-4- <br />Address �1Q�KS---------------City/State/ZIP: ------ -L--L��Q�. <br />Event Location (Please describe): <br />Length of Event (Dates/Times): --- lj-� 3 ____lprn-- <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 />• <br />Organization Name: � � —10 Je _k_�.ICJ1Wjagrees to indemnify, defend <br />and hold harmless the Civil City of South Bend, Indiana, frm anyjability, 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: __ 1 /_.�[ _ _______- <br />Authorized Organizer <br />Printed Name and Title <br />