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E <br />•M r!'nr •"u 'n'r <br />City of South Bend special Events Committee <br />Indemnity & Hold Harmless Agreement <br />Date: V I I I W L�_ Event <br />Event Name: <br />Applicant (Contact) Name: <br />Phone: -,) J'r <br />Email: <br />Address: <br />Event Location (Please d� n�ppe): 1, <br />V I <br />Length of Event (Dates/Times): Y <br />I <br />�A <br />Phone: <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: Id Mill ��U, 04V _agrees toindemnify, defend <br />and hold harmless the Civil City of ScWth 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:112, <br />41 <br />Signature <br />40 <br />rnnteu rvame anu i me <br />