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5M CONTRACTING, INC. (2)
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5M CONTRACTING, INC. (2)
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Last modified
1/29/2024 11:14:06 AM
Creation date
10/26/2023 11:20:26 AM
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Contracts
Company Name
5M CONTRACTING, INC.
Contract #
N-2023-293
Agency
Human Resources
Expiration Date
7/1/2024
Destruction Year
2029
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ENDORSEMENT AGREEMENT <br />WAIVER OF SUBROGATION REP D1 <br />BLANKET BASIS 9330685-23 <br />NEW <br />NA <br />5-43-90-02 <br />PAGE 1 <br />HOME OFFICE <br />SAN FRANCISCO EFFECTIVE JANUARY 1, 2023 AT 12.01 A.M. <br />ALL EFFECTIVE DATES ARE AND EXPIRING JANUARY 1, 2024 AT 12.01 A.M. <br />AT 12,01 AM PACIFIC <br />STANDARD TIME OR THE <br />TIME INDICATED AT <br />PACIFIC STANDARD TIME <br />5M CONTRACTING INC <br />2681 DOW AVE STE Cl <br />TUSTIN, CA 92780 <br />WE HAVE THE RIGHT TO RECOVER OUR PAYMENTS FROM ANYONE <br />LIABLE FOR AN INJURY COVERED BY THIS POLICY. WE WILL <br />NOT ENFORCE OUR RIGHT AGAINST THE PERSON OR <br />ORGANIZATION NAMED IN THE SCHEDULE. <br />THIS AGREEMENT APPLIES ONLY TO THE EXTENT THAT YOU <br />PERFORM WORE UNDER A WRITTEN CONTRACT THAT REQUIRES YOU <br />TO OBTAIN THIS AGREEMENT FROM US. <br />THE ADDITIONAL PREMIUM FOR THIS ENDORSEMENT SHALL BE <br />2.00% OF THE TOTAL POLICY PREMIUM. <br />4*4@02491001D <br />ANY PERSON OR ORGANIZATION <br />FOR WHOM THE NAMED INSURED <br />HAS AGREED BY WRITTEN <br />CONTRACT TO FURNISH THIS <br />WAIVER <br />JOB DESCRIPTION <br />BLANKET WAIVER OF <br />SUBROGATION <br />NOTHING IN THIS ENDORSEMENT SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND <br />ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY <br />OTHER THAN AS ABOVE STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE <br />HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR <br />LIMITATIONS IN THIS ENDORSEMENT. <br />COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: JANUARY 18, 2023 "MmVwwdDiv� <br />/J R�Ewm S ApmR Br. <br />2572 <br />/ Risk PAnnagement Matyst <br />AUTHORIZED REPRESEN/� TA'fIVE PRESIDENT AND CEC - <br />SCIF FORM 10217 IREVA-201M uw ur ci, <br />
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