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CIVIL SOURCE, INC - 2016
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CIVIL SOURCE, INC - 2016
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Last modified
3/25/2020 9:25:01 AM
Creation date
11/8/2016 3:37:59 PM
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Contracts
Company Name
CIVIL SOURCE, INC
Contract #
A-2016-283
Agency
PUBLIC WORKS
Council Approval Date
10/4/2016
Expiration Date
10/5/2019
Insurance Exp Date
5/1/2019
Destruction Year
0
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Workers' Compensation <br />This endorsement changes the policy to which it is attached. <br />It is agreed that Part One - Workers' Compensation Insurance G. Recovery From Others and Part Two - <br />Employers' Liability Insurance H. Recovery From Others are amended by adding the following: <br />We will not enforce our right to recover against persons or organizations. (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 />PREMIUM CHARGE - Refer to the Schedule of Operations <br />The charge will be an amount to which you and we agree that is a percentage of the total standard premium for <br />California exposure. The amount is Blanket Waiver of Subrogation Percentage Charge%. <br />All other terms and conditions of the policy remain unchanged. <br />This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers, <br />takes effect on the Policy Effective date of said policy at the hour stated in said policy, unless another <br />effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy <br />unless another expiration date is shown below. <br />P9• Of <br />REVIEWE <br />By Margaret Mercer at 11:05 am, Aug 08, 2018 <br />Form No: G-19160-B (11-1997) Policy No: 6057040558 <br />Endorsement Effective Date: 05/01/2018 <br />° Copyright CNA All Rights Reserved. <br />
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