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City of South Bend Special Events Committee <br />Indemnity & Hold Harmless Agreement <br />Date: f Z02-cl Event Date: / C) f / 20 Z y <br />Event Name: Gh401A Poe/4 n 4A!SIA 641-ADO d A?ce flo deen <br />Organization: Ci�e�O ' ^ / (7a�.t Ic /U a 1 S 1% 6 • e l.o o d <br />Applicant (Contact) Name: .! 0 4 n .D n. j nS <br />Applicant (Contact) Phone: 3 ff 3 ' to 3 `1 V Alt. Phone: <br />Email: 1 ezr.Am,,b&5 %•( / 91. C.e'yt <br />• Address: Sc 4 9 C✓o e c 5+ ,4-.rc City/State/ZIP: $a v i-h. (,3 a r .J /N Y <br />Event Location (Please describe): <br />M04,+o✓ f/aa[ 6e4t. en roe et>t y Pc.j k- ,4w S.I3. <br />,F.. ^ a.h„t ^ . / Ll en ly - s t%t f -f A c -eat J l- e n.d .it.foK t do <br />6 C4%tecen jOoL. k d- +t,e r� Iesil P4"Il. Alle..j <br />Length of Event (Dates/Times): s .. d o% O t uh 2 1- 'Z: o D Ted opt <br />APPLICANT agrees to indemnify, defend and hold harmless the Civil City of South Bend, Indiana, from any <br />liability, loss, costs, damages or expenses, including attorney fees, which the Civil City of South Bend, may suffer <br />or incur as a result of any claims or actions which maybe made against the City, its agents, employees, or <br />subdivisions by any person, including a participant in the activity, arising out of the approval of this request by <br />the Civil City of South Bend, Indiana, through the Board of Public Works, to close a portion of the public right-of- <br />way for the event described above, or for any harm or damage alleged to have occurred because of the holding <br />of the special event. The undersigned certifies that he/she is authorized to bind the APPLICANTto these terms. <br />Signed on this Date: <br />. AuthorizeiT Organizer Signature <br />,Joan �Do...+tis <br />pr g w w t T ti' <br />Printed Name and Title <br />