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Firefox <br />about:blank <br />Section K - Indemnity & Hold Harmless Agreement <br />• City of south Bend Special Events Committee <br />Indemnity & Hold Harmless Agreement <br />Event Date: vie <br />Event Name: <br />Applicant (Contact) Name: /ZIIIAVV <br />Applicant (Co--ntt/act)Phone, ,SS-1o2�7 Alt. Phone: <br />Email: // -oly.� 1a1;e(.494Vr /1601 <br />/L <br />Event Location (Please describe <br />L ee�o1°r r� <br />Length of Event (Dates/Times): � / �/r%e 162 16 A06i - AM Q` 180w <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: ! edA Cr�/'es to indemnify, defend <br />and hold harmless the Civil City of South Bend, Indiana, from any I iabior 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 maybe 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: O .a 7 .7 <br />Printed Name and Title <br />• <br />8of10 <br />3/14/2024,5:05 PM <br />