Laserfiche WebLink
<br />. -, <br /> <br />WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY <br /> <br />we 252 <br />(4-84) <br /> <br />WC 04 03 06 lEd. 4-64) <br />WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT- <br /> <br />This endorsement changes the policy to which it is attached effective on the inception date of the poiicy (miess a <br />different date is indicated below. <br />(The following "attaching cl~use. n0ed be compl@tedonlywhen this endorsement IS issued subsequent to preparation ollhe policy) <br /> <br />This endorsement, effective an <br /> <br />11/01/05 <br />[DAlE) <br /> <br />at 12:01 A. M. standard time, forms a part of <br /> <br />Policy No. <br /> <br />7160-35-81 <br /> <br />of the <br /> <br />FEDERAL INSURANCE COMPANY <br />(NAME OF INSURANCE COMPANY) <br /> <br />issued to <br /> <br />ACE PARKING MANAGEMENT, INC. <br />(SEE NAMED INSURED ENDT.) <br /> <br />Endorssment No. <br /> <br />We have the right to recover our paymen1s fram anyone liable for an injury covered by this policy. We will not enforce <br />our right against the pe.rson or organizatIon named in the Schedule. (This agreement applies only to the extent that you <br />pertarm work under a writ1en contract that requires you to obtain this agreement trom us.} <br />Y QU must maintain payroll records accurately segregating the remuneration of your employees while engaged in the <br />work described in the Schedule. <br /> <br />The additional premium lor this endorsement shall be 0 b/Q of the California workers' compensation premium <br />otherw"lse due on such remuneration. <br /> <br />Schedule <br /> <br />Person or Organization <br /> <br />Job Description <br /> <br />BLANKET WHERE REQUIRED BY <br /> <br />WRmEN CONTRACT <br /> <br />we 252 (4-84) <br />we 04 03 06 (Ed 4.84) <br /> <br />~ &/t{ <br /> <br />Page 1 of 1 <br />