Laserfiche WebLink
Section K - Indemnity & Hold Harmless ALereement <br />. City of South Bend Special Events Committee <br />Indemnity & Hold Harmless Agreement <br />Date: �� Z 3 Event Date: TI z 3 <br />Event NameCL 6 <br />• <br />Organization: S -t -Jvferk Vkili <br />Applicant (Contact) Name: /(K <br />Applicant (Contact) Phone: 111 - 1 % <br />Email: Vl rAl11 11 i O f ?i 2 D D (v A <br />Address: <br />i11 <br />w, <br />Alt. Phone: <br />City/State/ZIP: S 0 V'{ � b el,'J , 1 N '{ 6 61:— <br />Event l,ocation (Please describe): I <br />0V+ ANd bdGLe fct(Q S�a(rT�hg Q'F st.S re P4 F"r" I g p;n1 a„ <br />Q1Ls+ fjL(2 vtor-K, �6 t%'Iy Cfaff roll eye a„a 1;,cc4 o r4%- 'ore, . <br />Length of Event (Dates/Times): <br />✓Pbl+ A It 12- 12 <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: s�. -)—yS eP L r K.(1 S L agrees to indemnify, defend <br />and hold harmless the Civil City of South Bend, In Tana, 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 />Signed on this Date: I I ;;' I 2; <br />01'1+ got" r1,• .1u, tf <br />Authorized Organizer Signature <br />f '— ce9.e1 )ems Re-(6er <br />0 <br />Printed Name and Title <br />