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From: Thomas Story Fax: (866) 610-8379 To: +15742359171 Fax: +15742369171 Page 3 of 3 07l0672016 9:62 AM <br />PERMIT/AGREENl NT <br />FOR A PROCESSION <br />I. Sponsor shall reimburse the Board for the actual cost: to the City for the event, if deemed <br />necessary. <br />2. Sponsor shall ,provide to the Board a C.ertifteato of Insurance showing a liability policy in <br />full farce and effect with limits of $300,000.00 per occurrence and $5,000,000.00. <br />aggregate and the City of South Bend listed as an additional named insured for this event. <br />3. Sponsor shall provide to the Board all additional licenses, permits and documentation <br />required for the event. <br />4. Sponsor agrees to abide by all terms and conditions of the Board's policy governing <br />walks, rubs; parades or other similar event adopted by the Hoard on Much 3, 1985. <br />5 In. order to ensure public safety during the event, the Board ads to furnish traffic <br />planning, materials, equipment and personnel as deemed necessary by the Police <br />Department Traffic Bureau, the Bureau of Traffic and lighting, and, where applicable, <br />the Board of Park Commissioners. <br />6. Sponsor acknowledges ihat:the Police Department reserves the right to change this route <br />for safety purposes. <br />7. In consideration for approval 'by the Board and the use of the sidewalks for the purposes <br />act out above, the undersigned agrees and undertakes to hold the Civil City of South. <br />Bend, Indiana, fits and harmless fiom any :liability leas, costs, costs, damages or, <br />expenses, including attorney fees, which the Civil City of South Bend may suffer or <br />incur, as a result of any claims or actions which may be Haute by any person, including a <br />participant in said activity, arising out of the approval of the request to use the sidewalks <br />indicated in the City of South Bend. The undersigned certifies that hetsha is authorized to <br />bind dx%ubvve mentioned sponsor to the terms hereof- <br />$. Nottflewhin of wrovul/ at of &is teoww will be is med by return of this farusy upon <br />signed autlfarkwien by the Board 4Pghfic Works <br />I understand the above rules and regulatlotts and that this application may be denied based on <br />any false or incomplete inl' urrr adon. <br />Sponsor Signature <br />= T L:,,, <br />Title <br />D OF PUBLIC WORKS APPROVAL <br />_r er <br />Member ADue <br />RETURN FORM TO. <br />rtuard OfNbnc Works <br />1n6 county-chy Building <br />227 Wcat Perrargort scaievard <br />SouM Wad, IN 46641 <br />Phone, (574)2,15-425t* Fwc.(574) 235.4171 a-E-Mail: pubHcwk tioWbbcndia,gnv <br />