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PERMIT/AGREEMENT <br />FOR A PROCESSION <br />1. 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 oard a Certificate of Insurance showing a liability policy in <br />frill farce and effect with !limits of $300,000.00 per occurrence and $5,000,000.00 <br />aggregate and the City of South Bend listed as an additional named insured for this event. <br />3. Sponsor shall provide to thl Board all additional licenses, permits and documentation <br />required for the event. <br />4. Sponsor agrees to abide by' all terms and conditions of the Board's policy governing <br />walks, runs, parades or other imilar event adopted by the Board on March 3, 1985. <br />5. In order to ensure public safety during the event, the Board agrees to furnish traffic <br />planning, materials, equipment and personnel as deemed necessary by the Police <br />Department Traffic Bureau, the Bureau of Traffic and Lighting, and, where applicable, <br />the Board of Park Commissioners. <br />i <br />6. Sponsor acknowledges that the Police Department reserves the right to change this route <br />for safety purposes. <br />7. In consideration for approval by the Board and the use of the sidewalks for the purposes <br />set out above, the undersigned agrees and undertakes to hold the Civil City of South <br />Bend, Indiana, free and harmless from any liability loss, costs, costs, damages or <br />expenses, including attorney fees, which the Civil City of South Bend may suffer or <br />incur, as a result of any claims or actions which may be made by any person, including a <br />participant in said activity, arising out of the approval of the request to use the sidewalks <br />indicated in the City of South Bend. The undersigned certifies that he/she is authorized to <br />bind the above mentioned sponsor to the terms hereof. <br />$. Notrfrcadon of approvalldeniall of this request will be issued by return of this form, upon <br />signed authorization by the Board of Public Works <br />I understand the above rules and regulations and that this application may be denied based on <br />any false or incomplete information. 3 <br />M� <br />Sponsor Signature -� <br />Printed Name `fie V1 � ,; I t, <br />Title <br />OARD <br />President <br />Member <br />r- d ?1e izS � e � L" <br />ber <br />.APPROVAL <br />Member <br />Date <br />IRTUM FORM TO: <br />Board of Public Works <br />I316 County -City Building <br />227 West Jefferson Boulevard <br />I South Bend, IN 46601 <br />Phone: (574) 235-9251 9 FaX: (574) 235-9171 0 E-Mail: publicwks@soulhbendin.gov <br />N <br />