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WILLDAN HOMELAND SOLUTIONS 6A -2013
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WILLDAN HOMELAND SOLUTIONS 6A -2013
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Last modified
4/2/2014 8:42:29 AM
Creation date
1/28/2014 12:46:57 PM
Metadata
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Template:
Contracts
Company Name
WILLDAN HOMELAND SOLUTIONS
Contract #
A-2013-124
Agency
POLICE
Council Approval Date
8/5/2013
Expiration Date
8/31/2014
Insurance Exp Date
11/9/2014
Destruction Year
2019
Notes
A-2012-184;
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Workers' Compensation and Employers' Liability Insurance Policy <br />Waiver of Our Right to Recover From Others Endorsement - California <br />WC 04 03 06 <br />If the following information is not complete, refer to the appropriate Schedule attached to the policy. <br />Insured:Willdan Homeland Solutions <br />Producer: Dealey, Renton & Associates <br />Schedule <br />Person or Organization <br />City of Santa Ana <br />Attn: Clerk of the City Council <br />20 Civic Center Plaza (M -30) <br />Santa Ana CA 92702 -1988 <br />Additional Premium % <br />We have the right to recover our payments from any- <br />one liable for an injury- covered by this policy. We <br />will not enforce our right against the person or <br />organization named in the Schedule. (This agreement <br />applies only to the extent that you perform work <br />under a written contract that requires you to obtain <br />this agreement from us.) <br />ftww°i:G4� <br />Authorized Representative <br />WC040306 <br />Policy Number WZP81007462 <br />Effective Date 11/2/2012 <br />Job Description <br />For which the insured has agreed by <br />written contract executed prior to loss <br />to furnish this waiver. The premium <br />charge is 28 of policy standard premium <br />at final audit. <br />You must maintain payroll records accurately segre- <br />gating the remuneration of your employees while en- <br />gaged in the work described in the Schedule. <br />The additional premium for this endorsement shall be <br />the percentage, as shown in the Schedule applicable <br />to this endorsement, of the California workers' <br />compensation premium otherwise due on such <br />remuneration. <br />
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