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• Section K - Indemnity & Hold Harmless Aereem n <br />City of South Bend Special Events Committee <br />Indemnity & Hold Harmless Agreement <br />Date: �I ( 1 Event Date: (L Z—% <br />Event Name: i , — <br />Organization: <br />Applicant (Contact) Name: \ T <br />Applicant(Contact)Phone: `iI f - f� }I `i Aft. Phone: <br />Email: <br />Address:3L, J. fir. / City/State/ZIP: .(l]jaj)IIk <br />Event Location (Please describe): �1 <br />GAkl -St 0 )Q-v I �.�rl QYl rw iQ �Qn� <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 />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: V--i ) U )( I 1W <br />agrees to indemnity, defend <br />and hold harmless the Civil City of South Bind, Indiana, 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: <br />Organizer Signature <br />ems <br />