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RJM DESIGN GROUP INC. -2009
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RJM DESIGN GROUP INC. -2009
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Last modified
10/11/2018 8:48:52 AM
Creation date
7/31/2009 10:07:16 AM
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Contracts
Company Name
RJM DESIGN GROUP INC.
Contract #
A-2009-023
Agency
PLANNING & BUILDING
Council Approval Date
3/2/2009
Insurance Exp Date
9/30/2019
Destruction Year
2017
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Al <br />TRAVELERS J WORKERS COMPENSATION <br />AND <br />ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY <br />EART70RD, CT 06183 <br />ENDORSEMENT WC 99 03 76 ( A) — 001 <br />POLICY NUMBER: -UB-3761T93-2 <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 03.00 % of the California workers' compensation pre- <br />mium. <br />Schedule <br />Person or Organization Job Description <br />ANY PERSON OR ORGANIZATION FOR <br />WHICH THE INSURED HAS AGREYD <br />BY WRITTEN CONTRACT 87i;ECUTED <br />PRIOR TO LOSS TO FURNISH <br />THIS WAIVER. <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 Premium <br />Insurance Company Countersigned by_� <br />DATE OF ISSUE: 917112 ST ASSIGN: Page f of 1 <br />
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