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Section E - Indemnity & Hold Harmless Agreement <br />City of South Bend Special Events Committee <br />is Indemnity & Hold Harmless Agreement <br />Date: 741Tf 1vj � Event Date: lac- b-tS r fl, <br />Event Name:_ 1e4'/y <br />Organization: Se" 4L 13 eA- T�.�r4 Ve. �/ack e o(4 U /n I�-sC wa a K <br />Applicant (Contact) Name: �L41 a !sue N Yn i Ile; Aft <br />Applicant (Contact) Phone: f %/ 3 6y` R A' X Alt. Phone: <br />Email: fn, </ SA i 8. ✓ c>A • C o <br />Address: 1 o /SoA. 3 3 S City/State/ZIP: -roe�2`4- ACA4 Z`r "ftc 7-/4 <br />Event Location (Please describe): <br />Length of Event (Dates/Times): <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: 7. /ram }vSS <br />`)yLc.cai 2&,. f <br />Authorized Organizer Signature <br />i'N cc, r t w X, Ile.t <br />Printed Name and Title <br />0 <br />