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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: f3 / 20.75 Event Date: 1/14.490 t 4
<br />Event Name: /NMrcN Fol GFc - 5o✓rw Bcvf>
<br />Organization:_R,&.rr To (,r,c A&WIUA . /Na.
<br />Applicant (Contact) Name: %%oN,O /IA1¢c.N /
<br />Applicant (Contact) Phone: 574. ,m 5,19--p Alt. Phone: S74. $8b. e74/0
<br />Email: ,r% a1z4
<br />Address: -201>4 ,Rom. -Pop enems ,5,,,, /3aCity/State2lP: Sa,m ffrNa, iN ` (rba,S"'
<br />Event Location (Please describe):
<br />PEALfFVL aALK FRort Au,s.rrc or Gow,wo,.,► f/A.c -ry fa��IrL fau,�TNa�ts6
<br />Length of Event(DatesMmes): l/f1/.20.24 /.t►ot - ,lH/Ao?`l i oM
<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: R,bwr TO GIfE 1Y1cis,R✓.7 /Nc agrees to indemnify, defend
<br />and hold harmless the Civil City of South Bend, Indiana, 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 D /A14l-,WA-3
<br />Organizer
<br />Aros7,0 AgpM1 j# I , 6i-an7yc / ,,*.r'r 'A! L,fr 1*A4vl,vu4
<br />0 Printed Name and Title
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