Special Event - Angel of Hope Memorial Ride-August 16 2025

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• IF YOU ARE USING AND/OR CLOSING PUBLIC SIDEWALKS OR STREETS: You are required to notify area business owners and residents in writing 15 days prior to the event. Attach a copy of the brochure or door hanger distributed to all affected residents/businesses/neighborhood groups describing the event purpose, date and time. Section F - Insurance A Certificate of Insurance (copy) confirming the existence of a liability policy (General Liability and Automobile Liability) of not less than $700,000 per occurrence and $1,000,000 aggregate, which specifically names the City of South Bend, IN as an additionally insured for the event must be submitted. Copy of Certificate of Insurance must be submitted two (2) weeks prior to the date of the event City of South Bend special Events Committee Indemnity & Hold Harmless Agreement Date: /,O AWcl. Event Date: ,u s+ Event Name: I Organization: T h e f /1C K O-F :m D(Prr1A_ Applicant (Contact) Name: Applicant (Contact) Phone: 5-7 Y - ZO - I Y 9 9 Alt. Phone: Email: UWk \yC-,.,Oe('s40? 5� "� /,�+my,.7 Address: 2.0 L,-) gM' S( City/State/ZIP: /•��S ��`^ A� �iV. tl6�y Event Location (Please describe): Length of Event(Dates/Times): Og-/6-zazS Insurance Amount: This event is insured for no less than $700,000 per occurrence and $1,000,000 in aggregate, and the certificate of insurance includes a rider naming City of South Bend, Special Events Committee, and Board of Public Works as additionally insured for the event.