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CROSSTOWN DATA AND ELECTRIC, INC.-2013
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CROSSTOWN DATA AND ELECTRIC, INC.-2013
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Last modified
5/7/2013 3:52:40 PM
Creation date
5/6/2013 2:32:32 PM
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Contracts
Company Name
CROSSTOWN DATA AND ELECTRIC, INC.
Contract #
N-2013-052
Agency
PUBLIC WORKS
Expiration Date
10/31/2013
Insurance Exp Date
6/3/2013
Destruction Year
2018
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ZURICH <br />WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY <br />WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT- <br />CALIFORNIA <br />We have the right to recover from 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. (This agreement applies only to the extent <br />that you perform work under a written contract that requires you to obtain this agreement from us.) <br />You must maintain payroll records accurately segregating the remuneration ofyour employees while engaged in the <br />work described in the Schedule. <br />The additional premium for this endorsement shall be 0.0 % of the California workers' compensation premium <br />otherwise due on such remumeration. <br />SCHEDULE <br />Person or Organization: <br />Any person or organization that the insured is required by written contract to name as an additional insured. <br />CITY OF SANTA ANA, ALONG WITI I ITS OFFICER£i, AGENTS, REPRESENTATIVES, & EMPLOYEES ARE LISTED AS ADDITIONAL <br />INSURED; RE; CITY OF SANTA ANA / TRAFFIC ENOINGLRING (CT 1605) <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 eudoracment is issued subsequent to preparation of the policy.) <br />Endorsement Effective: 06/03/2012 Policy No.: WC966082001 Endorsement NO,: I <br />Named Insured: CROSSTOWN ELECTRICAL & DATA, INC. <br />Policy Effective Date: 06/03/2012 to 06/03/2013 <br />Insurance Company: AMERICAN ZURICH INSURANCE COMPANY <br /> <br />Countersigned By <br />WC 252 (4-84) <br />WC 04 03 06 (Ed. 4-84)
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