Laserfiche WebLink
AVIl► WORKERS COMPENSATION <br /> TRAVELERS J AND <br /> EMPLOYERS LIABILITY POLICY <br /> ENDORSEMENT WC 99 03 76( A)— <br /> POLICY NUMBER: UB-7W504031-25-26-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 % of the California workers'compensation pre- <br /> mium. <br /> Schedule <br /> Person or Organization Job Description <br /> As required by written contract <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. UB-7VV504031-25-26-G Endorsement No. <br /> Insured 06/03/2025 <br /> Premium <br /> Insurance Company Countersigned by <br /> Trevelers Property Casualty Company <br /> DATE OF ISSUE: - - ST ASSIGN: Page 1 of 1 <br />