Laserfiche WebLink
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 34 <br />(Ed. 8-00) <br />WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - BLANKET <br />We have the right to recover our payments from anyone liable for an Injury covered by this policy, We will not enforce <br />our right against the person or organization named In the Schedule. (This agreement applies only to the extent that <br />you perform work under a written contract that requires you to obtain this agreement from us). <br />The additional premium for this endorsement shall be 3 % of the total California Workers' Compensation premium <br />otherwise due, <br />Schedule <br />Person or Organization Job Description <br />ANY PERSON OR ALL CALIFORNIA <br />ORGANIZATION FOR OPERATIONS, <br />WHOM THIS WAIVER IS <br />REQUIRED. <br />APPROVED AS T FC11e';', r <br />",q A-, v"n", <br />Laura A. Rossini <br />,kssistan.t City Attorney <br />This endorsement changes the policy to which It Is attached and Is effective on the date Issued unless otherwise staled. <br />(The information below is required only when this endorsement is issued subsequent to preparation of the policy.) <br />EndorsementEffectfve 04-01-13 PollcyNo. WSD5020'17001 Endorsement No. <br />Insured;MetroPro Road Services, Inc. Premium$ INCL. <br />Insurance Company INSURANCE COMPANY OF THE WEST <br />Countersigned By <br />WC 99 00 34 <br />(Ed. &00) <br />INSURED