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Section It - Indemnity &--Hold Harm less Agreement <br />City of South Bend Special Events Committee <br />Indemnity & Hold Harmless Agreement <br />Date: Z/1 I 1q, Event Date: L n e 2 G' ZO '- <br />Event Name: t Q r �i) s LA r,'s/ -P /c " <br />Organization:_Lifit' � ,¢ t�u /,-P ej n4 r-.4 J/-.a it Cti ✓rc7i <br />Applicant (Contact) Name; ri !z L, n <br />Applicant (Contact) Phone: Z6D - - S Alt. Phone: '5-7- -?6 o <br />Email: klSb 7� <br />Address: City/State/ZIP: Sov-lh )-:�e'j 1�'j <br />Event Location (Please describe): SG;� � /cO� q L �6. r3u4 � � `�` e�fc 1� 1-26 <br />S� Itia �P "Wa ltl�s� o n 7 U hGa1 S-i �� llca s SL. Sov 4h on Ilou�s <br />5 L b I o c ksi �` COI vPr Cq 1VPr4 r '� Gu (ad l p <br />/4v^4)0,nl CUvYCti, 967q //J �11V���' S�, ��U��� /�Pr� J'3 <br />Length of Event (Dates/Times): nQ 211 ZQ Z 5 7_ ; S „, _ 4 S „r, <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: 6Pe, I/gdx e -C -� tl Gb -.-elk L��n�d+ _ 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 maybe 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 />c/ <br />Signed on this Date:. /1 1 126 L5 <br />Authorized Organizer Signature <br />Printed Name and Title <br />