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Section K - Indemnity & Hold Harmless Agreement <br />E <br />r-1 <br />f►� <br />40 <br />City of South Bend Special Events Committee <br />Indemnity & Hold Harmless Agreement <br />Date: �' '1- ,�Event Date: !- 913 - oC 01 <br />Event Name:�CNIV��v �j� j T FOMVA-L, <br />Organization: <br />Applicant (Coi <br />Applicant (Contact)Phone: 5-7Ll' O-QD-aal(0(0 Alt. Phone: <br />Email: <br />Address- nl`n WJI I�l-VU City/State/ZII <br />Event Location (Please describe): <br />K?-\PAuc-r� o cr <br />C.EN'CE-2- -�( Lo I & C ? aq ni l� <br />I ��-Z Ai oAJ6 Pa4nT- FWD <br />Length of Event (Dates/Times): 15\ %0" +���t%`� �/ J o���� 1 0�—Lg if /- t <br />Insurance Amount: This event is insured for no less than $700,000 per occurrence and $1,000,000 in aggregate, <br />and the certificate of insurance includes a rider naming City of South Bend, Special Events Committee, and Board <br />of Public Works as additionally insured for the event. <br />Organization Name: 1._J� \ 6 `� \ l � V J aerees to indemnifv dPfanri <br />and hold harmless the Civil City of South Bend, Indiana, from any liability, loss, costs, damages or expenses, <br />including attorney fees, which the Civil City of South Bend, Indiana, may suffer or incur as a result of any claims <br />or actions which may be made against the City, its agents, employees, or subdivisions by any person, including a <br />participant in the activity, arising out of the approval of this request by the Civil City of South Bend, Indiana, <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 />R l�AH tJ*,-� l AIJ- 1 - tVet�W Ce�t�R ► ,J A'CoCL <br />Printed Name and Title <br />