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PERM 1 (2/12)
4, Payment & Release of Liens. Permittee shall be responsible for the payment of all costs and
materials relating to its work in the public right-of-way, and agrees to defend and save harmless NYSDOT against
any and all lien claims made by persons supplying services or materials to Permittee in connection with
Permittee’s work.
5. Indemnity. In addition to the protection afforded to NYSDOT under any available insurance,
NYSDOT shall not be liable for any damage or injury to the Permittee, its agents, employees, or to any other
person, or to any property, occurring on the site or in any way associated with Permittee’s activities or
operations, whether undertaken by Permittee’s own forces or by contractors or other agents working on
Permittee’s behalf. To the fullest extent permitted by law, the Permittee agrees to defend, indemnify and
hold harmless the State of New York, NYSDOT, and their agents from and against all claims, damages, losses
and expenses, including but not limited to, claims for personal injuries, property damage, wrongful death,
and/or environmental claims and attorney fees arising out of any such claim, that are in any way associated
with the Permittee’s, activities or operations under any and all permits issued using this Undertaking.
FURTHERMORE, Permittee hereby warrants that the obligations of this Undertaking are backed by the
full faith and credit of Permittee. Permittee may insure or bond any of the obligations set forth herein, or may
rely upon self-insurance, budgeted funds, or funds for general operations.
This Undertaking shall be applicable to all permitted activities and operations undertaken after the date
of execution and work initiated while this Undertaking is in effect. This Undertaking may be revoked by the
Permittee or rejected by NYSDOT upon thirty days written notice but will continue to apply to all permitted
activities/operations that were permitted by virtue of this Undertaking. Unless terminated for the purpose of
future activities/operations, this Undertaking shall have a term of twenty (20) years and shall be kept on file to
facilitate the issuance of future permits to which it will apply.
IN WITNESS WHEREOF, (Municipality-
County, Town, City, Village or federal agency) agrees to the terms of this Undertaking, and has caused its
execution by the authorized officer or employee (attach Resolution of Approval).
Authorized Agent Date
Print Name/Title
{ )
Address Phone number
Address e-mail
NYSDOT PERM 1 (rev. 2/12)