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Section K - Indemnity & Hold Harmless A reement <br />City of South Bend Special Events Committee <br />Indemnity & Hold Harmless Agreement <br />Date: _11 1 61 h S Event Date: <br />Event Name: A4R l U F REM D <br />Organization: R ( ( 41 TO U LE M� CH I_aNA , 1 n1C. <br />Applicant (Contact) Name: GR FF(N N� A F 1 E <br />Applicant (Contact) Phone: Alt. Phone: C11 <br />Email: DU Kk1 PcCH (2 F1(t0LLFE6AICH(&(1JA, oRG <br />Address: n 01� 1 M W 0Q D G L I 5 r r 13 O City/State/ZIP: S O U r H BP N O, i N Lt6� 3 <br />Event Location (Please describe): <br />Length of Event (Dates/Times): F' 2 3� a ` I PM <br />Insurance Amount: This event is insured for no less than $1,000,000 per occurrence and $2,000,000 in <br />aggregate, and the certificate of insurance includes a rider naming City of South Bend, Special Events Committee, <br />and Board of Public Works as additionally insured for the event. <br />Organization Name: 1` 16 To 0 Fe M i (-H( A N A. I Ai r agrees to indemnify, defend <br />and hold harmless the City of South Bend, Indiana, its agents, officers, and employees (collectively ("City'), <br />from any liability, loss, costs, damages or expenses, including attorney fees, which the City, may suffer or incur <br />as a result of any claims or actions which may be made against the City, its agents, employees, or subdivisions <br />by any person, including a participant in the activity, arising out of the approval of this request by the City, <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: 1 j ` 0 3 <br />Authorized Organizer Signature: <br />r N �F�c� IN tjP � <br />Printed Name and Title: <br />