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• City of South Bend Special Events Committee <br />Indemnity & Hold Harmless Agreement <br />Date: Da I 10q 2-02-4;^ Event Date: 09/1-,2, 1 /ZOZ4�- <br />Event Name: — — ja r}-�j AD'V <br />Organization: N 14A <br />Applicant (Contact) Name: M A n 'q va U jEi OS}LJ�� �L <br />(S Applicant (Contact) Phone: 70 57 -- (o '-� Phone: S 1— Alt. <br />Email: I oY,Q-; M <br />Address: WS 3 S t -" ff D r. City/State/ZIP: <br />Event Location (Please describe): <br />,may, ren -NaLaj o f-+ so )/'dS C,'n <br />o.r�A u.0 C0-n Ct, 0-%re44- <br />Length of Event (Dates/Times): <br />— OS//3 <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 attorneyfees, which the Civil Cityof 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 Cityof 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: 0LI�UL <br />Authorized Organizer Signature <br />W 0 n-'g toe Urk <br />Printed Name and Title <br />• <br />to — V--Gr� Z <br />