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• City of South Bend Special Events Committee <br />Ind.ernni:i& H-ld -Ag,----.tnt <br />Date: n Event Date: <br />( <br />Event N~ <br />Organization: <br />Applicant ,Con=)Name: �t 1� t u✓Vl �1 CJtiC rL <br />Applicant(Contact)Phone: S7y-gg0- osSy Alt Phone: <br />Email: Y�YTeCr►+�O<[!yY_ //9 Rd9/►7c��/.C_CJH'i <br />Address: /l D9 i' 0 -Le- - 5 4- City/State/ZIP: <br />Event Location Mease describe}: <br />Length of E.mcr:t <br />L' 0akr 5 ►- - K uska'� N� l�r� �1� <br />— i. n w— <br />• APPLICANT agrees to indemnify, defend and hold harmless the Civil City of South Send, lndiana,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 arr; tiaims or actions wtkh may be made against the City, its Wnts. eff4ftyees, or <br />subdivisions by any person, inching a participant in the activity, arising out of the approval of this request by <br />the Civil City of South Send, Indiana, through the Board of Public Works, to close a portion of the public right-of- <br />way for the evert drdribcd fix, or for xW I`w m or d----ve a to have- tt::xred °becasr of tl a& holding <br />of the special event The undersigned certifies that he/she is authorized to bind the AMDiiCAN T to these terms. <br />Signed on Of* SAxe: L a03 5� <br />Authorized Organizer Signature <br />///lepi�i LqS/Ce. <br />Printed Mime and r & <br />