Laserfiche WebLink
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY <br />WC 99 0410B <br />(Ed.9-14) <br />WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA <br />BLANKET BASIS A- 7-017, 3h`f <br />/j . 2-017 , 2-a3 <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 you <br />perform work under a written contract that requires you to obtain this agreement from us.) <br />The additional premium for this endorsement shall be 2% of the total manual premium otherwise due on such <br />remuneration. The minimum premium for this endorsement is $350. <br />This agreement shall not operate directly or indirectly to benefit anyone not named In the Schedule. <br />SCHEDULE <br />BLANKET WAIVER <br />Person/Organization Blanket Waiver - Any person or organization for whom the Named Insured has <br />agreed by written contract to furnish this waiver. <br />Job Description <br />All CA Operations <br />&/1711 s, Pr ye- 2- -G <br />This endorsement changes the policy to which it is attached and is effective an 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 09/01/2017 <br />Insured Houston & Harris PCS, Inc. <br />Insurance Company Cypress Insurance Company <br />WC 99 04 1913 <br />(Ed.9-14) <br />Policy No. HOWC807872 <br />Countersigned by <br />Endorsement No. <br />Premium $ <br />