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Section K - Indemnity & Hold Harmless Agreement <br />is City of South Bend Special Events Committee <br />Indemnity & Hold Harmless Agreement <br />Date: `t f / h ° Event Date: <br />Event Name: S R. (- 6l o r R sJ rn <br />Organization: <br />Tt-e Kroc, cer--er <br />Applicant (Contact) Name: <br />f-Le xr-o i M. c- c o M Lb 4, <br />Applicant (Contact) Phone: 5-?-N- 31 `f a S % C� Alt. Phone: <br />Email: <br />£t_fANOR-MCC OM2Sti(eUSO <br />•SAc %/ATZ.onrARMY. <br />okfr <br />Address: <br />'bd'O `-J N£S-rfRN AVE <br />City/State/ZIP: SO'QTrl <br />SEND SI`N Ltlft" <br />Event Location Please describe): <br />SAY r�`'ni s�. k'I�ke %roc C&N� f-. <br />Length of Event (Dates/Times): t:ut"- <br />- 6/a%S /aoaS <br />yt66o( <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: Tt-e Km r- G. a ker- 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 />Authorized Organizer Signature <br />%A NO McL()M=SH - HEAGIH+ RCC OLPE(-Top <br />40 Printed Name and Title <br />