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Section K - Indemnity & Hold Harmless Agreement <br />City of South Bend Special Events Committee <br />• Indemnity & Hold Harmless Agreement <br />Date: / e k ZZi ZBZ'S Event Date: Qald l3, 60Z S <br />Event Name: L%✓t Z[)ayl a/ ,I -le Cress /'iUtrss/a., <br />Organization: <br />Applicant (Coi <br />Applicant(Contact)Phone: ufo- c{tiZ- /6�18 Alt. Phone: 5-7V- 72'7 - 1-7 /1C) <br />Email: !1IaAdn'gan n. o 5A. 119 <br />Address: 73/ /y, (lQ 1 ✓or/ Sl City/State/ZIP: So✓at ;3 Ad /Pi c%(o(o/3 <br />Event Location (Please describe): C)M)5 oia p� Qy �q� o� A0/U,)�?n, CA �k0l,'c <br />Cl1urclI, 0Z5 Gtl. ritl✓ora Si 9Ad In <br />lze .1,W e e, /3iu a 5 r.or! AZ)( <br />Length of Event (Dates/Times): /g, ZQ ZS /0 1 3d .gym <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 />• <br />Organization Name: `,r- /may GI Alpmay 6AaA (/,vr,-% agrees to indemnify, defend <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 />Signed on this Date: Z( Z`( IZ 'S <br />Authorized Organizer Signature <br />Printed Name and Title <br />