WATER WORKS ENGINEERS, LLC - Laserfiche WebLink

Home Browse Search

Workers' Compensation and Employers' Liability Policy Named Insured Endorsement Number WATER WORKS ENGINEERS, LLC 7500 N DOBSON RD STE 200 SCOTTSDALE, AZ 85266-2723 Policy Number Symbol: WLR Number: C72438553 Policy Period Effective Date of Endorsement 10/01/2024 To 10/01/2025 03/18/2025 Issued By (Name o nsurance Company) Indemnity Insurance Company of North America Insertt a policy number. T e remainder of the information is to be completed only when this endorsement isissued subsequent to the preparation of the policy. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise staled, CALIFORNIA WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement applies only to the insurance provided by the policy because California is shown in Item 3.A. of the Information Page. We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule, but this waiver applies only with respect to bodily injury arising out of the operations described in the Schedule, where you are required by a written contract to obtain this waiver from us. You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. Schedule 1. ( X) Specific Waiver Name of person or organization: City of Santa Ana -Public Works Agency P.O. Box 1988 Santa Ana, CA 92702-1988 WAIVER OF SUBROGATION IN FAVOR OF City of Santa Ana Its City Council officers officials employees agents and volunteers WHEN REQUIRED BY WRITTEN CONTRACT. ( ) Blanket Waiver Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. 2. Operations: 3. Premium: The premium charge for this endorsement shall be INCLUDED percent of the California premium developed on payroll in connection with work performed for the above person(s) or organization(s) arising out of the operations described. 4. Minimum Premium: INCLUDED Authorized Agent VVU aU U3 fo (UO/18)