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• City of South Bend Special Events Committee <br />Indemnity & Hold Harmless Agreement <br />Date: 0 Z074 EEv^v�enttAD�,ate: �� .2-07- <br />/V/1�h� <br />Event Name: <br />Organization:<<✓ /V�'�N ✓vT�S'� (�''++/y��£'��t�^b'r�� <br />Applicant (Contact) Name: ffAmi4 <7C.kUT% <br />Applicant (Contact) Phone: S77 a23 Z- 7 B- Alt. Phone: <br />Email: 4A✓I d re, fore I ear-Aori',� vje4. ar9 1 <br />Address: IDD-7 �b r 4 aA� � City/State/ZIP: P � t'N 4 to & l (o <br />Event Location (Please describe): <br />NIV,Al /91W/1 ,t3u�ld /oo; -/or3 on•! on Cc �� �orrl a '� <br />Co�ley� Qrg AN -IS • <br />Length of Event (Dates/Times): L.1O Z-4 )2 Ob (Vt " prbl <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: MCar �o"*we' G,�4(0ar)G0ol 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 Date: <br />Signature <br />2 _kl_ <br />• Printed Name and Title <br />