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GRAFFITI PROTECTIVE COATINGS, INC. 2015-2017
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GRAFFITI PROTECTIVE COATINGS, INC. 2015-2017
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Last modified
3/25/2020 9:56:16 AM
Creation date
12/21/2015 4:10:55 PM
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Contracts
Company Name
GRAFFITI PROTECTIVE COATINGS, INC.
Contract #
A-2015-239
Agency
PUBLIC WORKS
Council Approval Date
10/20/2015
Expiration Date
10/31/2017
Insurance Exp Date
1/1/2018
Destruction Year
2022
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WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY WC 04 03 06 <br />(Ed. 4-84) <br />WAIVER OF OUR RIGHT TOR ECOVER FROM OTHERS ENDORSEMENT- <br />CALIFORNIA <br />Yk have the right to recover our payments from anyone liable for an injury covered by this policy. M will not <br />enforce our right against the person or organization named in the Schedule. (This agreement applies only to the <br />extent 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 of your employees while engaged it) <br />the work described in the Schedule. <br />The additional premium for this endorserwnt shall be 0 , 00 % of the California workerscompensation pre- <br />mium otherwise due on such remuneration. <br />Person or Organization <br />ALL PERSONS AND/OR <br />ORGANIZATIONS THAT <br />ARE REQUIRED BY <br />WRITTEN CONTRACT OR <br />AGREEMENT WITH THE <br />INSURED, EXECUTED <br />PRIOR TO THE <br />ACCIDENT OR LOSS, <br />THAT WAIVER OF <br />SUBROGATION BE <br />PROVIDED UNDER THIS <br />POLICY FOR WORK <br />PERFORMED BY YOU FOR <br />THAT PERSON AND/OR <br />ORGANIZATION <br />VVC 252 ("4) <br />WO 04 03 06 (Ed. 4-84) <br />Schedule <br />Job Description <br />ALL CA OPERATIONS <br />Page 1 of I <br />jl-Ck' I 'k '` ( <"` <br />A ��AO 6?-_ A (M <br />
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