NMDOT_Indemnification_and_Hold_Harmless_Agreement.pdf
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- Attached to
- Carbon Coal Road, McKinley County Industrial Park Waterline - US Department of Commerce (EDA) 08-79-05634
- Solicitation number
- ITB-2609
- Issued by
- Quay County, New Mexico
About this file
This is an Indemnification and Hold Harmless Agreement form issued by the New Mexico Department of Transportation (NMDOT) for entities conducting activities on state highways. The agreement requires the sponsoring entity to defend, protect, indemnify, and hold harmless NMDOT from all personal injury or property damage resulting from the specified activity. The form is a template that must be completed with details regarding the activity type, date, location (including specific mileposts and routes), and the authorized representative signing on behalf of the entity. The agreement applies to activities conducted on state highways and requires execution before NMDOT officials and a notary public.
The sponsoring entity must obtain liability insurance with a minimum coverage of one million dollars ($1,000,000.00) per occurrence and designate NMDOT as an additional insured. A certificate of insurance in a form acceptable to NMDOT must be provided prior to the event; failure to submit timely proof of insurance constitutes grounds for cancellation of NMDOT's approval for any road closures associated with the activity. This standard agreement template applies to the Carbon Coal Road, McKinley County Industrial Park Waterline Project in Gallup, New Mexico, which involves installation of waterline infrastructure on public roads and therefore requires compliance with NMDOT's indemnification requirements for highway use and temporary road closures during construction activities.
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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 .