Laserfiche WebLink
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 89 06 00 B <br /> (Ed. 7-01) <br /> POLICY INFORMATION PAGE ENDORSEMENT <br /> The following item(s) <br /> F, Insured's Name (WC 89 06 01) r Item 3,13, Limits (WC 89 06 12) <br /> Policy Number(WC 89 06 02) r Item 3.C.States (WC 89 06 13) <br /> Effective Date(WC 89 06 03) )t Item 3.D.Endorsement Numbers(WC 89 0614) <br /> j Expiration Date(WC 89 06 04) ❑ Item 4.*Class, Rate,Other(WC 89 04 15) <br /> ❑ Insured's Mailing Address(WC 89 06 05) ❑ Interim Adjustment of Premium(WC 89 04 18) <br /> ❑ Experience Modification (WC 89 04 06) ❑ Carrier Servicing Office (WC 89 06 17) <br /> ❑ Producer's Name(WC 89 06 07) ❑ Interstate/intrastate Risk ID Number(WC 89 0618) <br /> ❑ Change in Workplace of Insured(WC 89 06 08) ❑ Carrier Number(WC 89 06 19) <br /> ❑ Insured's Legal Status(WC 89 06 10) ❑ Issuing AgencylProducer Office Address(WC 89 06 25) <br /> ❑ Item 3.A.States (WC 89 06 11) <br /> is changed to read: <br /> It is understood and agreed that: <br /> The following forms are added: <br /> WC 00 03 13-Waiver Of Our Right To Recover From Others Endorsement <br /> All other terms and conditions remain unchanged. <br /> *Item 3.D. Change to <br /> Form Number Form Title <br /> WC 89 06 00 3(07-01) Policy Information Page Endorsement <br /> WC 04.03 06 Waiver of Our Right to Recover from Others Endorsement--California <br /> WC 89 06 OOB <br /> (Ed.7-01) <br /> m 2001 National Council on Compensation Insurance,Inc. <br />