Special Event - St. Nick 6 -December 2

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Section K - Indemnity & Hold Harmless Ajereement • City of South Bend Special Events Committee Indemnity & Hold Harmless Agreement Date: �� l Z 3 Event Date: ITi z 3 Event NameCL 6 Organization: s f L, 041I Applicant (Contact) Name: / WK Applicant (Contact) Phone: Email: V1 oh'1 11 i O f ?i 2 D D (v A � Address: w, Alt. Phone: City/State/ZIP: s C V'{ 4 b e,'J F IN t 6 6 P— Event l,ocation (Please describe)- 0 lI � f // I p i, V+avid bdce (ctcf- S�e(�"I Ohl{ Gf+4.Torer� i of"" I goifnl on Q1Ls+ oLce vtor-K �6 l%'Iy cf/off evil eye And 6dc�c n r4-.--�'orerl, . Length of Event (Dates/Times): ✓ e bl+ Wit- I t 17- 12 Insurance Amount: This event is insured for no less than $700.000 per occurrence and $1,000,000 in aggregate, • and the certificate of insurance includes a rider naming City of South Bend, Special Events Committee. and Board of Public Works as additionally insured for the event. JrganizationName: S+ -'T-0SevL ek l S L. agrees to indemnify, defend and hold harmless the Civil City of South Bend. In Tana, from any liability, loss, costs, damages or expenses, including attorney fees, which the Civil City of South Bend, Indiana. may suffer or incur as a result of any claims or actions which may be made against the City, its agents, employees, or subdivisions by any person, including a participant in the activity, arising out of the approval of this request by the Civil City of South Bend, Indiana, through the Board of Public Works, to close a portion of the public right-of-way for the event described above. or for any harm or damage alleged to have occurred because of the holding of the special event. The undersigned certifies that he/she is authorized to bind the APPLICANT to these terms. Signed on this Date: I ! ;�- I 2; 01.1-6t0i," r.t,-.1u,'tf Authorized Organizer Signature IN ,tkl M 1rl: I I" F f'— c b 9.e ;4- S e-f 6 e r 0 Printed Name and Title