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Section K - Indemnity & Hold Harmless Agreement <br />• City of South Bend Special Events Committee <br />Indemnity & Hold Harmless Agreement <br />Date: h5IIl1I'I.� Event Date: jJI IV 1IZ� <br />Event Name: q o � (`1I'( Q <br />UI <br />Organization: A V T ��� Q I,, , <br />Applicant (Contact) Name: t / t t V � (A ) Q y �, <br />Applicant (Contact) Phone- 1�'� .� _ 5S �f�/ Alt. Phone: <br />Email: D56i nGhi'ZO SO J -� tI�1 Chd 10 -(AnV <br />� 55• �,acz,�Address:�City/State/ZIP: i N <br />Event Location (Pleas djyescribe): <br />Nowotr_ M21q S. S4, COVE G1 Vd S9, ►n) ti(Arvi7 <br />Length of Event (Dates/Times): 6" 0 d p m PM <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: L�.yY1 V E'Yll,t)"-< I t'tl' I s agrees to indemnify, defend <br />and hold harmless the Civil 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 />Printed Name and Title <br />40 <br />