Laserfiche WebLink
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 34 <br />(Ed. 8-00) <br />WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - BLANKET <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 />The additional premium for this endorsement shall be <br />otherwise due. <br />Person or Organization <br />ANY PERSON OR <br />ORGANIZATION WHEN <br />REQUIRED BY WRITTEN <br />CONTRACT <br />2 % of the total California Workers' Compensation premium <br />Schedule <br />Job Description <br />ALL CA OPERATIONS <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 03/22/2021 Policy No. WPL 5036116 04 <br />Insured APPLIED TECHNOLOGY GROUP INC <br />Insurance Company INSURANCE COMPANY OF THE WEST <br />WC 99 06 34 <br />(Ed. 8-00) <br />Countersigned By <br />INSNRm <br />Endorsement No. <br />Premium $ INCL. <br />RmltMmm8 madDmsion <br />ram, <br />RENe1vEo&pAPrRO By:: <br />��llr11-1F L' Ff�E IA4 VAad <br />®' Ruk Management Analyn <br />