Laserfiche WebLink
Section E - Indemnity & Hold Harmless Agreement <br />City of South Bend Special Events Committee <br />• Indemnity & Hold Harmless Agreement <br />Date: q� <br />Event Name: f ( ( 6 <br />Organization: itirU'a <br />Applicant (Contact) Name: <br />Applicant (Contact) Phone: — <br />Email: QDO�LI�G[ /G�f'(Jb <br />Address: <br />Event Date: uir%z 41 7.vZ-f <br />aj r rc11•(z � Pik, <br />Event Location (Please describe): j t Sys. <br />O <br />(,a C.ioje .ice V4,lorma <br />Length of Event (Dates/Times): <br />r& I I <br />Alt. Phone: 5.4 `i3 0 <br />1. C a=rn <br />r City/State/ZIP: <br />rLt jo".v <br />4 0--p, - _Sj,� v,0 40 <br />b�ak'40U41 CZM'''Lj to. 3Jp4� <br />• APPLICANT agrees to indemnify, defend and hold harmless the Civil City of South Bend, Indiana, from any <br />liability, loss, costs, damages or expenses, including attorney fees, which the Civil City of South Bend, may suffer <br />or incur as a result of any claims or actions which may be made against the City, its agents, employees, or <br />subdivisions by any person, including a participant in the activity, arising out of the approval of this request by <br />the Civil City of South Bend, Indiana, through the Board of Public Works, to close a portion of the public right-of- <br />way for the event described above, or for any harm or damage alleged to have occurred because of the holding <br />of the special event. The undersigned certifies that he/she is authorized to bind the APPLICANT to these terms. <br />tl-2z-3oa`f <br />Signed on this Date: <br />zz-'e (241a-161 <br />Authorized Organizer Signature <br />Printed Name and Title <br />