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Last modified
5/27/2021 1:33:12 PM
Creation date
4/22/2021 12:12:58 PM
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Contracts
Company Name
COMMUNITY PARTNERS
Contract #
N-2021-076
Agency
Parks, Recreation, & Community Services
Expiration Date
12/31/2021
Insurance Exp Date
10/1/2021
Destruction Year
2026
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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 <br />(Ed. 4-84) <br />WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT <br />We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce <br />our right against the person or organization named in the Schedule. (This agreement applies only to the extent that <br />you perform work under a written contract that requires you to obtain this agreement from us.) <br />This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. <br />Schedule <br />PER POLICY CONTRACT <br />This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. <br />(The information below is required only when this endorsement is issued subsequent to preparation of the policy.) <br />Endorsement Effective Date:10 / 01 / 2 0 2 0 Policy No. 0357952 0 7 -15 713 6 Endorsement No. <br />Policy Effective Date: 10 / 01 / 2 0 2 0 to 10 / 01 / 2 0 21 Premium $ <br />Insured: COMMUNITY PARTNERS <br />DBA: <br />Carrier Name / Code: Church Mutual Insurance Company <br />WC 00 03 13 Countersigned by Risk MmRgmadDiveaian <br />(Ed.4-84) ecREVIEWED&APPROVED BY.- <br />© 1983 National Council on Compensation Insurance.` Risk Management Analyst <br />
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