Laserfiche WebLink
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY <br /> TEXAS WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT <br /> This endorsement applies only to the insurance provided by the policy because Texas is shown in Item 3.A. of the <br /> Information Page. <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, but this waiver applies only with <br /> respect to bodily injury arising out of the operations described in the Schedule where you are required by a written <br /> contract to obtain this waiver from us. <br /> This endorsement shall not operate directly or indirectly to benefit anyone not named in the Schedule. <br /> The premium for this endorsement is shown in the Schedule. <br /> Schedule <br /> 1. O Specific Waiver <br /> Name of person or organization <br /> (X) Blanket Waiver <br /> Any person or organization for whom the Named Insured has agreed by written contract to furnish this <br /> Waiver. ALL PERSONS OR ORGANIZATIONS ON FILE WITH THE <br /> INSURED <br /> 2. Operations: <br /> 3. Premium <br /> The premium charge for this endorsement shall be 2.0 percent of the premium developed on payroll in <br /> connection with work performed for the above person(s) or organization(s) arising out of the operations <br /> described. <br /> 4. Advance Premium <br /> This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. <br /> (The Information below is required only when this endorsement is issued subsequent to preparation of the policy.) <br /> Endorsement Effective 09/01/2024 Policy No, 406-04-54-43-0006 Endorsement No. <br /> insured E.J. WARD. INC. Premium$ <br /> Insurance Company Atlantic Specialty Insurance Company <br /> Countersigned By <br /> WC 42 03 04B 06 14 E-INSURED Page 1 of 1 <br />