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 <br />otherwise due. <br />Person or Organization <br />ANY PERSON OR <br />ORGANIZATION WHEN <br />REQUIRED BY WRITTEN <br />CONTRACT <br />3 % of the total California Workers' Compensation premium <br />Schedule <br />Job Description <br />ALL CALIFORNIA JOBS <br />PERFORMED BY NAMED <br />INSURED. <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 06/03/2015 Policy No. WLV 5030354 00 <br />Insured CROSSTOWN ELECTRICAL & DATA <br />Insurance Company INSURANCE COMPANY OF THE WEST <br />Countersigned By <br />WC 99 06 34 /t (.9 <br />CROSST���1 C�j,6�)TRICAL &DATA A- 2012 -177 &EXTENSION REVIEWED BY " "" vvv"` <br />EUNICE HEREDIA (PG 10 OF 10) <br />INSURED <br />Endorsement No. <br />Premium $ INCL. <br />