Form PERM3 "Indemnification Agreement Between Municipality and NYS Dot" - New York

What Is Form PERM3?

This is a legal form that was released by the New York State Department of Transportation - a government authority operating within New York. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on February 1, 2003;
  • The latest edition provided by the New York State Department of Transportation;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form PERM3 by clicking the link below or browse more documents and templates provided by the New York State Department of Transportation.

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Download Form PERM3 "Indemnification Agreement Between Municipality and NYS Dot" - New York

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PERM 3 (2/03)
INDEMNIFICATION AGREEMENT
BETWEEN A MUNICIPALITY AND THE
NEW YORK STATE DEPARTMENT OF TRANSPORTATION
FOR SPECIAL HAULING PERMITS,
DIVISIBLE LOAD OVERWEIGHT PERMITS,
AND/OR
RESTRICTED VEHICLE PERMITS
This Agreement is made this
day of
20
, pursuant to the provisions of Part 154,
Title 17, Official Compilation of Codes, Rules and Regulations of the State of New York, by and between the People of
the State of New York, all municipal subdivisions thereof except the party of the second part, and the Commissioner of
the New York State Department of Transportation, the New York State Thruway Authority, the State Bridge Authority
and their officials, officers, agents and employees, parties of the first part, acting through and between the Commissioner
of
Transportation or his
designee (“DOT”) and ___________________________, party of the second part
(“Municipality”).
WHEREAS , _______________________________(Name of Municipality) intends to apply for and receive
p ermits pursuant to subpart 154-1 and/or subpart 154-2 of Title 17 of the official compilation of codes, rules and
regulations of the State of New York, from the Department of Transportation for the operation of certain of its vehicles;
and
WHEREAS , the Commissioner of Transportation has determined that this agreement will protect the interests
of the People of the State of New York to the same extent as protective liability insurance coverage;
NOW, THEREFORE, the parties hereto do agree as follows:
1. ____________________________(Name of Municipality), in lieu of obtaining protective liability insurance
coverage with respect to such permits, hereby agrees to assume the risk of, and to release, indemnify, protect, defend
and save harmless the parties of the first part and/or all employees of the party of the first part from and against any and
all claims, demands, actions, settlements, awards and judgements for such loss, injury, death or damage and any cost
or expense in connection therewith caused by or arising out of the issuance and/or use of such permits.
2. The party of the second part hereby agrees to indemnify and save harmless the parties of the first part and/or
all employees of the parties of the first part from all liability of claims, demands and costs for or arising out of the
issuance and/or use of such permits or the acceptance of such permits, whether caused by negligence of the part of the
second part or by anyone acting by, through or for the party of the second part or caused by negligence, including
omissions and supervisory acts, of the parties of the first part.
3. Any payments required by the foregoing will be guaranteed by the full faith and credit of the party of the
second part, or its districts, as applicable, and will be paid out of current budgeted funds, or if insufficient, from its
liability and casualty reserve fund or from the proceeds of bonds which current laws permit the party of the second part
to issue to pay claims against it.
PERM 3 (2/03)
INDEMNIFICATION AGREEMENT
BETWEEN A MUNICIPALITY AND THE
NEW YORK STATE DEPARTMENT OF TRANSPORTATION
FOR SPECIAL HAULING PERMITS,
DIVISIBLE LOAD OVERWEIGHT PERMITS,
AND/OR
RESTRICTED VEHICLE PERMITS
This Agreement is made this
day of
20
, pursuant to the provisions of Part 154,
Title 17, Official Compilation of Codes, Rules and Regulations of the State of New York, by and between the People of
the State of New York, all municipal subdivisions thereof except the party of the second part, and the Commissioner of
the New York State Department of Transportation, the New York State Thruway Authority, the State Bridge Authority
and their officials, officers, agents and employees, parties of the first part, acting through and between the Commissioner
of
Transportation or his
designee (“DOT”) and ___________________________, party of the second part
(“Municipality”).
WHEREAS , _______________________________(Name of Municipality) intends to apply for and receive
p ermits pursuant to subpart 154-1 and/or subpart 154-2 of Title 17 of the official compilation of codes, rules and
regulations of the State of New York, from the Department of Transportation for the operation of certain of its vehicles;
and
WHEREAS , the Commissioner of Transportation has determined that this agreement will protect the interests
of the People of the State of New York to the same extent as protective liability insurance coverage;
NOW, THEREFORE, the parties hereto do agree as follows:
1. ____________________________(Name of Municipality), in lieu of obtaining protective liability insurance
coverage with respect to such permits, hereby agrees to assume the risk of, and to release, indemnify, protect, defend
and save harmless the parties of the first part and/or all employees of the party of the first part from and against any and
all claims, demands, actions, settlements, awards and judgements for such loss, injury, death or damage and any cost
or expense in connection therewith caused by or arising out of the issuance and/or use of such permits.
2. The party of the second part hereby agrees to indemnify and save harmless the parties of the first part and/or
all employees of the parties of the first part from all liability of claims, demands and costs for or arising out of the
issuance and/or use of such permits or the acceptance of such permits, whether caused by negligence of the part of the
second part or by anyone acting by, through or for the party of the second part or caused by negligence, including
omissions and supervisory acts, of the parties of the first part.
3. Any payments required by the foregoing will be guaranteed by the full faith and credit of the party of the
second part, or its districts, as applicable, and will be paid out of current budgeted funds, or if insufficient, from its
liability and casualty reserve fund or from the proceeds of bonds which current laws permit the party of the second part
to issue to pay claims against it.
PERM 3 (2/03) Reverse
IN WITNESS WHEREOF, the State has caused this instrument to be signed by the Commissioner of
Transportation or his designee and the party of the second part has caused this instrument to be signed by
, as authorized by Resolution of
its
________________________________________, a copy which is annexed hereto.
__________________________________________
_________________________
New York State Department of Transportation
Date
__________________________________________
_________________________
Municipality
Date
Address:_________________________________________
__________________________________________
Telephone No.:____________________________________
Attach Copy of Resolution
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