2020/09/01 Hemet Fence Corp Waiver of Rights to RecoverWORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 34
(Ed. &00)
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - BLANKET
We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce
our right against the person or organization named in the Schedule. (This agreement applies only to the extent that
you perform work under a written contract that requires you to obtain this agreement from us).
The additional premium for this endorsement shall be
otherwise due.
Person or Organization
ANY
PERSON/ORGANIZATION
WHEN REQUIRED BY
WRITTEN CONTRACT
2 % of the total California Workers' Compensation premium
Schedule
Job Description
ALL CALIFORNIA
OPERATIONS
This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated.
(The information below is required only when this endorsement is issued subsequent to preparation of the policy.)
Endorsement Effective 03/01/2020 Policy No. WPL 5046493 01 Endorsement No.
Insured HEMET FENCE CORP Premium $ INCL .
Insurance Company INSURANCE COMPANY OF THE WEST
Countersigned By
WC 99 06 34
(Ed. 8-00)
INSURED