Laserfiche WebLink
TRAVELERS Ask WORKERS COMPENSATION <br /> AND <br /> ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY <br /> HARTFORD CT 06183 <br /> ENDORSEMENT WC 99 03 76 ( A)- 001 <br /> POLICY NUMBER: UB-7T437766-24-47-G <br /> WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS <br /> ENDORSEMENT — CALIFORNIA <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 2.00 % of the California workers' compensation pre- <br /> mium. <br /> Schedule <br /> Person or Organization Job Description <br /> ANY PERSON OR ORGANIZATION FOR ARCHITECTS PLAN <br /> WHICH THE INSURED HAS AGREED <br /> BY WRITTEN CONTRACT EXECUTED <br /> PRIOR TO LOSS TO FURNISH THIS <br /> WAIVER. <br /> INCLUDING: <br /> THE CITY OF OAKLAND, ITS <br /> COUNCILMEMBERS, DIRECTORS, <br /> OFFICERS, AGENTS, EMPLOYEES, <br /> AND VOLUNTEERS. <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 policy.) <br /> Endorsement Effective Policy No. Endorsement No. <br /> Insured <br /> �� RIkMnrwgemedDivisinn '. <br /> 3' \ REVIEWED&APPROVED BY; <br /> Insurance Company Countersigned by g; di <br /> A+•�:1 A aue 4 <br /> Risk Management Specialist <br /> DATE OF ISSUE: 08-19-24 ST ASSIGN: <br /> 82215271 I Master Certificate I Kathy Casey 110/1/2024 8:44:10 AM (EDT) I Page 16 of 16 <br /> This certificate cancels and supersedes ALL previously issued certificates. <br />