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• City of South Bend Special Events Committee <br />Indemnity & Hold Harmless Agreement <br />Date: _11'1117 orU47'7 Event Date: <br />Event Name: <br />Organization: <br />Applicant (Contact) Name: '-V-r, h <br />Applicant (Contact) Phone: �%yS%UR- Alt. Phone: S?y �IaU'aSa �4 <br />Email: L-A-1 WOVdXV I I U <br />td j city/Statel Address: A y `f <br />-/ <br />�L <br />Event Location (Please describe): �4 n5 CU rne� OF -Moak S-F at'u <br />5G�5Ko S4 IV Syr 'MIA <br />Length of Event (Dates/Times): 167- /CL/ rf 2cr7 7•' fSq — t8• C > U <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. ---')I . /"J r agrees to indemnify, defend <br />and hold harmless the Civil City of South Bend, In Tana, 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 />l <br />in� <br />• Printed Name and Title (.t�ST A&Z <br />