Laserfiche WebLink
WORKERS COWENSATZON <br /> TRAVELERS] AND <br /> ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY <br /> HARTFORD CT 06183 <br /> ENDORSEMENT WC 99 03 76( A)- 001 <br /> POLICY UB-7K72867624-43-G <br /> WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS <br /> ENDORSEMENT—CALIFORN <br /> (BLANKET WAIVER) <br /> We have the right to recover our payments from anyone liable for an injury covered by this policy.We will not <br /> enforce our right against the person or organization named in the Schedule. <br /> The additional premium for this endorsement shall be 2. oo %of the California workers'compensation pre- <br /> mium. <br /> Schedule <br /> Person orOrganizadon Job Description <br /> ANY PERSON OR OR6rlNJ;ZATIO FOR <br /> WHICH THE INSURED SAS AGREED <br /> BY WRITTEN CONTRACT EBECU'll1ro <br /> PRIOR TO LOSS TO FURNASH TRIS <br /> IMXVER. <br /> APPROVED <br /> By Cynthia Mora at 3:01 pm, Dec 04, 2024 <br /> This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise <br /> stated. <br /> (The information below is required only when this endorsement is issued subsequent to preparation of <br /> the pollcy.) <br /> Endorsement Effective Policy No. Endorsement No. <br /> Insured Premium <br /> Insurance Company <br /> DATE OF ISSUE:07/01/2024 ST ASSIGN: Pagel oft <br />