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Firefox <br />about:blank <br />• City of South Bend Special Events Committee <br />Indemnity & Hold Harmless Agreement <br />Date: <br />EventName: <br />Organization: S�/6E Yq <br />Applicant (Contact) Name: <br />�y�/ <br />Applicant (Contact) Phone: <br />Email: E li�rC%A/�4/TTQ <br />Address: /?Y` /I/ 104le11/ <br />Event Location (Please describe): <br />Event Date: Q% y e /T � 1,5,- aaas <br />1ee90er dirk <br />Length of Event (Dates/Times): 7&e /7/ cis ��4m �/y �`dU/Ie �J, a�5 /Ogm --:;;o1 <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 />Orpan l7atian Name: Y11Py �l/ vt'��r UD!'/M/ l/aerees to indemnifv. 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 />Printed Name and Title <br />Cl <br />8 of 10 3/14/2024, 5:05 PM <br />