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AEF SYSTEMS CONSULTING
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Last modified
4/28/2022 9:27:34 AM
Creation date
7/13/2021 2:59:02 PM
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Contracts
Company Name
AEF SYSTEMS CONSULTING
Contract #
N-2021-144
Agency
Parks, Recreation, & Community Services
Expiration Date
6/30/2022
Insurance Exp Date
8/23/2022
Destruction Year
2027
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THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />WAIVER OF OUR RIGHT TO RECOVER FROM <br />OTHERS ENDORSEMENT - CALIFORNIA <br />Policy Number: 72 WEC AB1Z5Q Endorsement Number: <br />Effective Date: 02/01/20 Effective hour is the same as stated on the Information Page of the policy. <br />Named Insured and Address: AEF Systems Consulting Inc <br />8502 E CHAPMAN AVE STE 376 <br />ORANGE CA 92869 <br />We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our <br />right against the person or organization named in the Schedule. (This agreement applies only to the extent that you <br />perform work under a written contract that requires you to obtain this agreement from us.) <br />You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work <br />described in the Schedule. <br />The additional premium for this endorsement shall be 2 % of the California workers' compensation premium otherwise due <br />on such remuneration. <br />SCHEDULE <br />Person or Organization <br />Job Description <br />Any person or organization from whom you are required by written contract or agreement to obtain this waiver of rights <br />from us <br />Countersigned by <br />RhkMwuganadDMslm <br />ReEWnrwm&Aaraw®Br ; <br />Form WC 04 03 06 (1) Printed in U.S.A. <br />Process Date: 12/23/19 Policy Ei MW R6kMrnrgem ntAnayst `'', <br />
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