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Section K - Indemnity & Hold Harmless Agreement <br />• City of South Bend Special Events Committee <br />Indemnity & Hold Harmless Agreement <br />Dater t,.-c 1-1, 2 o25 Event Date: c2=--71'7 C72h <br />Event Name: --Z SK t�wci t"". WAM <br />Organization: , t j cT� �t & CAA "V C � <br />Applicant (Contact) Name: Y) G\RT P_.rnnlx< <br />Applicant (Contact) Phone: Cr7�►41 ��i(7- (pa3� Alt. Phone: CS��{1 3'��1— l 7 &fj� <br />Email: <br />Address: Ill iid3S tkcgH.d,r;t\d, Ds City/State/ZIP: Sok Lr.ji` P 1-h(�3`7 <br />Event Location (Please describe): <br />Length of Event (Dates/Times): 23 YZ p�n+/S 1 �q 2� 'L17O, �g1.ti� I (= awe <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 />ok` v �t- K ME C u,.,,cL. `A 6A Quo v-,le D,0w ,e Nut <br />Organization Name: `5 GLA-Llt Vlcti xsm 1+41(o (-7 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 <br />O "a <br />• Printed Name and Title <br />