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Item 16 - Agreements for On -Call Environmental Services
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03/21/2023 Special and Regular
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Item 16 - Agreements for On -Call Environmental Services
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3/28/2024 10:33:33 AM
Creation date
8/11/2023 8:57:20 AM
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City Clerk
Item #
16
Date
3/21/2023
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DocuSign Envelope 10: FC7E9346-8A22-4923-BD05-AA3CA0439841 <br />Attachment Code: D574650 Certificate ID: 16765249 <br />WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 <br />WC0146330 Dudek 812812022812812023 (Ed.4-84) <br />WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT <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 you <br />perform work under a written contract that requires you to obtain this agreement from us.) <br />This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. <br />Schedule <br />ANY PERSON OR ORGANIZATION YOU ARE REQUIRED TO WAIVE YOUR RIGHTS OF <br />RECOVERY IN A WRITTEN CONTRACT, AGREEMENT OR PERMIT WITH THE NAMED <br />INSURED. <br />WC 00 03 13 <br />(BEd. 4-84) <br />1983 National Council on Compensation Insurance. <br />
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