F5109 - Deed of Indemnity

                                                 Deed of Indemnity for construction of
                                                 road works on a State-controlled road
                                                 (section 33 of the Transport Infrastructure Act 1994)

Department of Transport and Main Roads reference number
TMR

Contractor (insert name of contractor carrying out works, as shown on public liability insurance)



Road works (insert description of works and location)




I/We the contractor named above:
a.   indemnify the State of Queensland (represented by the department), its officers, employees and agents (the Indemnified)
     against any or all Losses suffered or incurred (except to the extent that any Losses are caused through the negligent act or
     omission of the Indemnified) in connection with the construction of the road works
b.   acknowledge that provision of this indemnity is a condition of approval of the road works under section 33 of the Transport
     Infrastructure Act.

In this deed, ‘Losses’ include liabilities, losses, damages, expenses and costs (including, legal costs on a full indemnity basis and
whether incurred or awarded) of any kind or nature whether arising in contract or tort (including, but not limited to negligence) or
under a statute, and also includes:
a.   loss of profits, loss of revenue, loss of anticipated savings, loss of opportunity, pure economic loss and loss of data
b.   any other consequential, special or indirect loss or damage.



Executed as a deed
For company:
Signed, sealed and delivered

on the ________________ day of ____________ 20 ____ in
accordance with section 127 of the Corporations Act 2001 (Cth).


________________________________________                              ________________________________________
Signature of director                                                 Signature of company secretary/director

________________________________________________                      ________________________________________________
Full name of director                                                 Full name of company secretary/director



For individual:
Signed, sealed and delivered by

________________________________________________


on the ________________ day of ____________ 20 ____ in
the presence of:

________________________________________                              ________________________________________
Signature of witness                                                  Signature

________________________________________________
Full name of witness

                                                                                                     TRB Forms Area Form F5109 CFD V01 May 2016