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GENERAL52058
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Last modified
8/24/2016 8:38:04 PM
Creation date
11/23/2007 7:24:39 PM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C1989074
IBM Index Class Name
General Documents
Doc Date
2/12/2004
Doc Name
Certificate of Liability Insurance
Permit Index Doc Type
Insurance
Media Type
D
Archive
No
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WORKERS COMPENSATION & EMPLOYERS LIABILITY POLICY WC 00 03 13 <br />WAVER OF SUBROGATION <br />WAIVER OF OUR RIGHT TO RECOVERY FROM OTHERS ENDORSEMENT <br />We have the right to recover our payments from anyone liable for an injury covered by this <br />policy. We will not enforce our right against the person or organization named in the Schedule. <br />(This agreement applies only [o the extent that you perform work under a written contract that <br />requires you to ohtain this agreement from us.) <br />This agreement shall not operate directly or indirectly to benefit anyone not named in the <br />Schedule. <br />Schedule <br />Name of Person or Organization <br />Any and all person(s) or organization(s) Re: All Operations <br />for whom the Named Insured ahs agreed <br />by written contract to furnish this <br />waiver, provided the written contract <br />was executed prior to any loss that is <br />subject to this endorsement. <br />All other terms and conditions of this policy remain unchagned. <br />Effective 07/01/03, this endorsement fom~s part of policy No. WC3374190-02 <br />Of Zurich American Insurance Co. <br />Issued to American Civil Constructors, Inc. <br />Endorsement No.: <br />AUTHORIZED REPRESENTATNE <br />Wc124(4-84) <br />Wc00 03 13 Copyright 1983 National Council on Compensation Insnrance <br />
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