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Section K - Indem ity & Hold Harmless Agree <br />City of South Bend Special Events Committee <br />Indemnity & Hold Harmless Agreement <br />Date: Event Date: <br />Event Name: <br />Organization: <br />Applicant (Contact) Name: -J(AI A,0 — /l CCdE <br />Applicant (Contact) Phone: -SILL -- �� - Alt Phone: <br />Email: <br />Address:._251 City/State/ZIP: G2 N �0 <br />Event Location (Please describe): <br />Length of Event (Dates/Times): ��zr I�a�s ltpM lG Zl f z�s <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 />40 of Public Works as additionally insured for the event. <br />Organization Name: -Tk L-�;m CrAjTE & 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: / - S Z025 <br />Organizer Signature <br />t00% Printed Name and Title <br />