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PLANETBIDS, INC
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Last modified
2/14/2022 2:58:55 PM
Creation date
2/14/2022 2:58:00 PM
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Contracts
Company Name
PLANETBIDS, INC
Contract #
A-2021-252
Agency
Public Works
Council Approval Date
12/21/2021
Expiration Date
12/21/2023
Insurance Exp Date
3/19/2022
Destruction Year
2028
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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: 46 WEC P16280 Endorsement Number: <br />Effective Date: 07/20/21 Effective hour is the same as stated on the Information Page of the policy. <br />Named Insured and Address: PLANETBIDS INC <br />13263 VENTURA BLVD STE 101 <br />STUDIO CITY CA 91604 <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 for whom you are required by written contract or agreement to obtain this waiver of rights from <br />us <br />Countersigned by <br />Form WC 04 03 06 (1) Printed in U.S.A. <br />Process Date: 06/10/21 Policy E <br />P.IekMnwgnnattD'rvvimt . <br />.4 /rREVIEWED&pAPPR..OttEDBY. <br />r'W�E D. �+uAALfC <br />Risk Management A,alyst <br />
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