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Last modified
7/12/2021 11:25:22 AM
Creation date
7/12/2021 11:24:05 AM
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Contracts
Company Name
MARK THOMAS
Contract #
A-2018-159-07A
Agency
Public Works
Council Approval Date
6/19/2018
Expiration Date
6/18/2023
Insurance Exp Date
9/15/2021
Destruction Year
2028
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POLICY NUMBER: 6078951371 COMMERCIAL AUTO <br />CA04441013 <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />WAIVER OF TRANSFER OF RIGHTS OF RECOVERY <br />AGAINST OTHERS TO US (WAIVER OF SUBROGATION) <br />This endorsement modifies insurance provided under the following: <br />AUTO DEALERS COVERAGE FORM <br />BUSINESS AUTO COVERAGE FORM <br />MOTOR CARRIER COVERAGE FORM <br />With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless <br />modified by the endorsement. <br />This endorsement changes the policy effective on the inception date of the policy unless another date is indicated <br />below. <br />Named Insured: MARK THOMAS & COMPANY, INC. <br />Endorsement Effective Date: 09/15/2020 <br />SCHEDULE <br />Name(s) Of Person(s) Or Organization(s): <br />Any person or organization with whom you have agreed in writing <br />in a contract or agreement to waive any right of recovery <br />against such person or organization, but only if the contract <br />or agreement: <br />1. Is in effect or becomes effective during the term <br />of this policy; and <br />2. Was executed prior to loss <br />Information required to complete this Schedule, if not shown above, will be shown in the Declarations. <br />The Transfer Of Rights Of Recovery Against <br />Others To Us condition does not apply to the <br />person(s) or organization(s) shown in the Schedule, <br />but only to the extent that subrogation is waived prior <br />to the "accident' or the 'loss" under a contract with <br />that person or organization. <br />CA 04 44 10 13 Copyright, Insurance Services Office, Inc., 2011 <br />577143D3 I NWT-i 120-23 master certificate I Pra hjot xa"r 1 9/23/2020 2:39:23 en (nor) I eas" 7 of u <br />,y4 RiekManagenentoMsbn <br />Imo. RBAEwta&pAPPROV®BY.' <br />r �IuuLult_+L' MNYA.f.i vj&4a <br />Rink Management Analyst <br />
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