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City of South Bend Special Events Committee <br />• Indemnity & Hold Harmless Agreement <br />Date: I %O 7 j Event Date: <br />Event Name: 1/VLQVi(O C Swu t t7' csLy-L <br />Organization: <br />Applicant (Contact) Name: late - <br />Applicant (Contact) Phone: V( - 7'1(o - 1 ` 3a Alt. Phone: <br />Email: -LI - coy-` <br />Address:Hli2> E- AA od City/State/ZIP: (eoOy- �2vEi itJ ib�IS <br />Event Location (Please describe): <br />yUIo'AC t'e Stjr'ter= L Lgcb-,U <br />Length of Event (Dates/7-imes): "S � 3 1 - <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 />Signed on this Date: , - -Lc L <br />Authorized Organizer Signature <br />Printed Name and Title <br />0 <br />