Laserfiche WebLink
M,1 1!'lll <br />City of South Bend Special Events Committee <br />• Indemnity & Hold Harmless Agreement <br />Date: �� at5 Event Date:1� <br />Event Name: �Gm,l.t t)�1 0-� <br />Organization: <br />Applicant (Contact) Name: M't c-,Vlec k L. L LyY �C. <br />Applicant(Contact)Phone: (�l9)')Ic;--113-1 Alt. Phone: <br />Email: <br />Address: 53a 5 S • Y_eyi Gku <br />S+. <br />City/State/ZIP: <br />v i <br />N ?>enak <br />3, ti(&Ig <br />Event Location (Please describe): rtVn2 <br />ewe k* <br />,1 \ h2 c A- <br />A ke\e <br />0,88v eSS <br />\'Q, vxe, to Vic.aS wek\ as O*k�r o.ci%:,+ies. <br />Length of Event (Dates/Times): NOD - IL). <br />5 + Up w, t\ be cai' l e•. <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 maybe 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: I'oC�S <br />Authorized Organizer Signature <br />j��leheAl l.. L.d\,q- - <br />Printed Name and Title <br />11 <br />