NMDOT_Indemnification_and_Hold_Harmless_Agreement.pdf
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- Solicitation number
- ITB-2612
- Issued by
- San Juan County, New Mexico
About this file
This document is an Indemnification and Hold Harmless Agreement form issued by the New Mexico Department of Transportation (NMDOT) for use by entities conducting activities on state highways. The agreement requires the sponsoring entity to defend, protect, indemnify, and hold harmless the NMDOT from all personal injury, property damage, and third-party claims resulting from activities conducted on specified state highway segments. The form is designed for completion by the authorized agent of the entity conducting the activity, with fields for the activity description, date, location, and milepost information. The agreement must be notarized and signed by both the authorized agent and a notary public.
A critical requirement of this agreement is that the sponsoring entity must obtain liability insurance in the amount of one million dollars ($1,000,000.00) per occurrence, naming the NMDOT as an additional insured. The entity must provide NMDOT with a certificate of insurance in a form acceptable to the department prior to the event or activity. The agreement explicitly states that failure to provide the certificate of insurance in a timely manner constitutes grounds for cancellation of NMDOT's approval for closing a state highway under a roadway work permit. This indemnification document applies to the City of Gallup's Well Contract No. 2 project, which involves installation of deep well submersible pump assemblies at two Point of Diversions locations along U.S. Highway 491 in McKinley County, New Mexico.
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Text version
NEW MEXICO DEPARTMENT OF TRANSPORTATION (NMDOT)
INDEMNIFICATION AND HOLD HARMLESS AGREEMENT
_____________________________________________________acting through its authorized agent, (entity) _____________________________________________________agrees to defend, protect, indemnify (person authorized to sign on behalf of entity) and hold harmless the New Mexico Department of Transportation (NMDOT) from all personal injury or property damage suffered by the _____________________________________, its members and (entity) participants, the NMDOT, or by third parties resulting from the________________________________ (activity) to be held on ______________________________ at or from milepost(s) _________________________ (date of activity) (mileposts) following route(s) ___________________________. Additionally the above agrees to obtain liability (route) insurance covering the event in the policy amount of one million dollars ($1,000,000.00) per occurrence, which names the NMDOT as an additional insured. Sponsor shall provide NMDOT with a certificate of insurance in a form satisfactory to NMDOT as evidence of the insurance coverage prior to the event.
Failure to timely provide a certificate of insurance shall be grounds for cancellation of NMDOT’s approval of the closing of a state highway for the roadway work permit.
Authorized Agent Signature__________________________________
SUBSCRIBED AND SWORN to before me this______________ day of ______________, 20___________
Notary Public Signature_______________________________________
My Commission Expires_______________________________________
File details come from the government source that posted it. Updated .