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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: Imo" rJ - 1 1- i O Event Date: '7 - n - ZS <br />Event Name: WeSWAC NQ 0kh6' CralFI- (=e51'ya( <br />Organization: UN'i G ay-Aens V'C- <br />Applicant (Contact) Name: S:t k OPtcan k v- <br />Applicant (Contact) Phone: 5-4-14 - S 3 Z - 7-368 Alt. Phone: 2Z Z -22 6 6 <br />Email: C 4ria0�c. Una ga✓AMg arq <br />v <br />Address: 3101 ?vafi IVA City/State/ZIP: 5.,Pt, f�A-11. ZAJ <br />Event Location (Please describe): <br />Length of Event (Dates/Times): <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: ... U Vl N ClardeKS 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 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 />• A(Cuvl�� r D1Fvcactt rGuch� �eord.Na¢.r <br />Printed Name and Title <br />