Laserfiche WebLink
CALIFORNIA WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT <br />This endorsement applies only to the insurance provided by the policy because California is shown in Item 3.A. of the <br />Information Page. <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, but this waiver applies only with respect to bodily injury <br />arising out of the operations described in the Schedule, where you are required by a written contract to obtain this waiver <br />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 />Schedule <br />1. (❑) Specific Waiver <br />Name of person or organization <br />BLANKET WAIVER - ANY PERSON OR ORGANIZATION <br />FOR WHOM THE NAMED INSURED HAS AGREED <br />BY WRITTEN CONTRACT TO FURNISH THIS WAIVER. <br />(❑x) Blanket Waiver <br />Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. <br />2. Operations: <br />ALL CALIFORNIA OPERATIONS <br />3. Premium: <br />The premium charge for this endorsement shall be 1 % percent of the California premium developed on payroll in <br />connection with work performed for the above person(s) or organization(s) arising out of the operations described. <br />4. Minimum Premium: <br />Authorized Representative <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 05-15-24 Policy No. 71750595 Endorsement No. 002 <br />Insured LIEBERT CASSIDY WHITMORE A PROFESSIONAL Premium $ Incl . <br />Insurance Company Federal Insurance Company <br />Countersigned By <br />WC 90 03 75 (05/18) <br />Insured Copy <br />