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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 Board a Certificate of Insurance showing a liability policy in <br />full force 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 walks, <br />runs, parades or other similar 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, the <br />Board of Park Commissioners. <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 Bend, <br />Indiana, free and harmless from any liability loss, costs, costs, damages or expenses, <br />including attorney fees, which the Civil City of South Bend may suffer or incur, as a result <br />of any claims or actions which may be made by any person, including a participant in said <br />activity, arising out of the approval of the request to use the sidewalks indicated in the City <br />of South Bend. The undersigned certifies that he/she is authorized to bind the above <br />mentioned sponsor to the terms hereof. <br />8. Notification of approval/denial of this rearrest will be issued by return of this form, upon signed <br />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. <br />Sponsor Signature <br />Printed Name V-P)),kC�xf�c <br />Titles etS C r -iS <br />OF P LIC WORKS APPROVAL <br />Member Member <br />_UL/4r7 <br />Member Date <br />RETURN FORM To: 2 <br />Board of Public Works <br />1316 County -City Building <br />227 West Jefferson Boulevard <br />South Send, IN 46601 <br />Plione: (574) 235-9251 a Fax: (574) 235-9171 s E-Mail: publiewks@southbendin.gov <br />