NMDOT_Indemnification_and_Hold_Harmless_Agreement_.pdf
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- Attached to
- New Sunshine Substation Site Preparation Specifications (Civil Grading & Drainage Phase) Re-Bid
- Solicitation number
- 2025-ITB-009
- Issued by
- Pierce County, New Mexico
About this file
The document is an Indemnification and Hold Harmless Agreement form from the New Mexico Department of Transportation (NMDOT), designed to protect the department from potential liability during an unspecified activity involving a third-party entity. The form requires the participating entity to agree to defend, protect, and indemnify NMDOT from any personal injury or property damage that may occur during an activity at specified mileposts and routes. The entity must also obtain liability insurance coverage of $1,000,000 per occurrence, with NMDOT named as an additional insured, and provide a certificate of insurance prior to the event.
The agreement serves as a standard risk mitigation document that mandates the sponsoring entity assume full responsibility for potential damages or injuries related to their activity on state highways. Failure to provide the required insurance certificate in a timely manner can result in cancellation of NMDOT's approval for closing a state highway or obtaining a roadway work permit. The form includes spaces for the authorized agent's signature, notarization, and details about the specific activity, route, and date, ensuring comprehensive documentation of the agreed-upon terms and protections for the state transportation department.
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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 .