NMDOT_Indemnification_and_Hold_Harmless_Agreement.pdf
PDF 100 KB Posted
- Attached to
- G-80 Well POD-1 and POD-2 Drilling and Testing
- Solicitation number
- 2025-ITB-005
- Issued by
- Quay County, New Mexico
About this file
The document is an Indemnification and Hold Harmless Agreement from the New Mexico Department of Transportation (NMDOT), a standard legal form designed to protect the state agency during activities conducted on state highways. The form requires an entity conducting an activity on a state route to obtain liability insurance of $1,000,000 per occurrence, name NMDOT as an additional insured, and provide a certificate of insurance prior to the event. The agreement covers potential personal injury or property damage suffered by the entity, its members and participants, NMDOT, or third parties resulting from the specified activity.
The agreement serves as a risk mitigation tool for NMDOT, ensuring that any organization using state highway routes has adequate insurance coverage and accepts legal responsibility for potential incidents. Failure to provide the required insurance certificate can result in cancellation of NMDOT's approval for closing a state highway or obtaining a roadway work permit. The form must be signed by an authorized agent of the entity, sworn before a notary public, and includes spaces to specify the specific route, mileposts, and date of the planned activity.
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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 .