HomeMy WebLinkAboutREQUEST TO INTERRUPT STATE ROUTE TRAFFIC FOR SPECIAL EVENTSTo be completed by local government
Name of Special Event: MEMORIAL 1bAy
SeRVICi:
Date of Event: A141 3/, Id 16
Times of Event: O:ooA 12:43P
City /County: Aug"s 74- iCHMoND
State Route No: 28
ATTACHMENT
to
REQUEST TO INTERRUPT STATE ROUTE TRAFFIC FOR SPECIAL EVENTS
TO: STATE DEPARTMENT OF TRANSPORTATION, TENNILLE, GEORGIA 31039
INDEMNIFICATION AND HOLD HAR -MLESS AGREEMENT
The undersigned agrees to indemnify and "hold harmless Georgia Department of Transportation, the State of Georgia, its agencies
and instrumentalities and all of their respective officers, members, employees and directors (collectively referred to as the "DOT ")
from and against any and all claims, demands, liabilities, losses, costs or expenses, including attorneys' fees, and from the payment of
any sum or sums of money to any persons whomsoever (including third persons -or subcontractors, employees or agents of the
undersigned or of DOT), for any loss due to personal injury, bodily injury, death, or property damage arising out of, attributable to or
resulting from this special event or in any way attributable to the location, construction, operation or maintenance of the traffic control
plan approved for this request; or due to any violation of the approval by the requesting party; or due to the application or violation of
any pertinent Federal, State or local law, rule or regulation in connection with this special event or the approved traffic control plan. If
and to the extent such damage or loss covered by this indemnification is paid by any State self - insured funds (the "Funds ") established
and maintained by the State of Georgia Department of Administrative Services Risk Management Division (DOAS)ihe undersigned
agrees to reimburse the Funds for such monies paid out by the Funds. The undersigned acknowledges that traffic control plans for
special events can be approved in situations where local streets are on or off the State Route System, and that the DOT makes no
warranty, express or implied, concerning the State Route System or local streets.and roads or other engineering considerations
involved in approving this traffic control plan. The undersigned further acknowledges that the DOT has relied upon the
representations made by the undersigned in requesting approval of the traffic control plan for this event, including the undersigned's
representations that all conditions of the plan shall be met and that the undersigned shall meet all DOT specifications, as well as all
relevant Federal, State and local laws, rules or regulations in the construction, maintenance, and operation of the approved traffic
control plan. This indemnification shall apply where the DOT may be partially responsible for the situation giving rise to the claim.
Requested this day of
By- a i�.� , i_�
Mayor /City Administrator
Witness:
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