NMDOT_Indemnification_and_Hold_Harmless_Agreement.pdf
PDF 100 KB Posted
- Solicitation number
- ITB-2617
- Issued by
- Mckinley County, New Mexico
About this file
This is an Indemnification and Hold Harmless Agreement form issued by the New Mexico Department of Transportation (NMDOT). The agreement establishes legal protections for NMDOT by requiring entities conducting activities on state highways to defend, protect, indemnify, and hold harmless the department from all claims of personal injury, property damage, or third-party losses arising from the specified activity. The agreement applies to activities conducted at designated mileposts along specified routes on identified dates. The form contains blank fields for the responsible entity to insert activity details, location information, dates, and authorized signatures.
The agreement requires the responsible entity to obtain and maintain liability insurance coverage in the amount of one million dollars ($1,000,000.00) per occurrence, with NMDOT named as an additional insured. The entity must provide NMDOT with a certificate of insurance in a form acceptable to NMDOT prior to the event. The agreement specifies that failure to timely provide proof of insurance constitutes grounds for cancellation of NMDOT's approval for closing a state highway or issuing a roadway work permit. The document requires notarization and includes signature blocks for the authorized agent and notary public, with spaces for the notary's commission expiration date.
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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 .