Laserfiche WebLink
Section E - Indemnity & Hold Harmless Agreement <br />• City of South Bend Special Events Committee <br />Indemnity & Hold Harmless Agreement <br />Date: `/hd /Za ZS Event Date: , /fg l26 zs <br />Event Name:_jl7w _(adL; a )-li,LU.. i (r,Ik0/L /71.::, y-nA <br />Organization: ter 1/2 4, r,P wt;6401N 61['aj tc Ciu to <br />Applicant (Contact) Name: H/ a" /n >1 d <br />Applicant (Contact) Phone: 26o-4ti2-m tJ4 Alt Phone: <br />Email h/o di; . pn CW r. I sL a ra l <br />Address: -711 PJ Cb I✓e, / I City/State2lP: 5ru-'I, ►ReA /111 cl&6l3 <br />Event Location (Please describe): <br />Event <br />)Z naor, G1:G0 <br />Length of Event (Dates/Times): 76 Z S %® nn, — Prr <br />Se+- / C4ccln - `,T_' <br />is <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-cf- <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 />�� <br />Signed on this Date: y Zs <br />Authorized Organizer Signature <br />L'[7 e" &n �GnO)ri 4C�n. 1 Q rlt <br />Printed Name and Title <br />0 <br />