Laserfiche WebLink
CNA G -19160-B <br />(Ed. 11197) <br />POLICY NU MBER: WC422998476 <br />WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY <br />BLANKET WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS <br />This endorsement changes the policy to which It Is attached. <br />It is agreed that Part One Workers' Compensation Insurance G. Recovery From Others and Part Two Employers' <br />Liability Insurance H. Recovery From Others are amended by adding the following: <br />We will not enforce our right to recover against persons or organizations. (This agreement applies only to the extent that <br />you perform work under a written contract that requires you to obtain this agreement from us,) <br />PREMIUM CHARGE - <br />The charge will be an amount to which you and we agree that is a percentage of the total standard premium for California <br />exposure. The amount is %, <br />c <br />o rollb[A <br />G -19160-B AP; ? `W-ATIB )'n1 <br />(Ed. 11/97) Page 1 of 1 <br />•_""'_._--LISA E. S it <br />Assistant city Attornays)s - <br />