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Section E - Indemnity & Hold Harmless Agreement <br />• City of South Bend Special Events Committee <br />Indemnity & Hold Harmless Agreement <br />Date: t71 n R ' Z S Event Date: b lr6 - , (0 ! Z S <br />Event Name: `j 1 1A ) S A3 trL-I 1A r) N\-� <br />Organization: <br />Applicant(Contact)Name: LS C\ L JA S NJ.C) Q-TZ \ S 2 Q <br />Applicant (Contact) Phone: y q b PAZ ID y (RAlt. Phone: Lk U S <br />Email 1e7" 1 V1,\-N 2% a Mr%A . C os tr1'\ <br />Address: E17 � City/State/ZIP: Ll 6�(p <br />Event Location (Please describe) <br />Length of Event (Dates/Times): <br />• APPLICANT agreesto indemnify, defend and hold harmless the Civil City of South Bend, Indiana, from any <br />liability, loss, costs, damages or expenses, including attorneyfees, 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-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: V �S <br />Organizer Signature <br />Printed Name and Title <br />0 <br />bt <br />