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11 <br />Date: <br />Event Name: <br />Organization: ( 14 N AS i <br />Applicant (Contact) Name: C. <br />Applic <br />Email: <br />Addre! <br />City of South Bend Special Events Committee <br />Indemnity & Hold Harmless Agreement <br />Event Date: 07 <br />Event cation (Please escribe): <br />4(,4e bt,�wz�e� -(- <br />Length of Event (Dates/Times): D 7 /a 6 I L) )L E j • 00 T <br />• APPLICANT agrees to indemnify, defend and hold harmless the Civil City of South Bend, Indiana, 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 any claims or actions which may be made against the City, its agents, employees, or <br />subdivisions by any person, including a participant in the activity, arising out of the approval of this request by <br />the Civil City of South Bend, Indiana, through the Board of Public Works, to close a portion of the public right-of- <br />way for the event described above, or for any harm or damage alleged to have occurred because of the holding <br />of the special event. The undersigned certifies that he/she is authorized to bind the APPLICANT to these terms. <br />Signed on this Date: <br />Authorized Organizer Signature <br />tM 5C"" AA4� <br />Printed Name and Title <br />0 <br />