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Last modified
12/5/2019 10:48:54 AM
Creation date
7/24/2018 10:46:37 AM
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Template:
Contracts
Company Name
NV5
Contract #
A-2018-160-04
Agency
PUBLIC WORKS
Council Approval Date
6/19/2018
Expiration Date
6/18/2021
Insurance Exp Date
5/1/2020
Destruction Year
2026
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POLICY NUMBER: 6057040575 COMMERCIAL AUTO <br />CA 04 44 03 10 <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />WAIVER OF TRANSFER OF RIGHTS OF RECOVERY <br />AGAINST OTHERS TO US (WAIVER OF SUBRQQATION) <br />This endorsement modifies insurance provided under the following: <br />BUSINESS AUTO COVERAGE FORM <br />BUSINESS AUTO PHYSICAL DAMAGE COVERAGE FORM <br />GARAGE COVERAGE FORM <br />MOTOR CARRIER COVERAGE FORM <br />TRUQKERS COVERAGE FORM <br />With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by <br />the endorsement. <br />This endorsement changes the policy effective on the inception date of the policy unless another date is indicated <br />below. <br />Named Insured: NV5 Global, Inc <br />Endorsement Effective Date: 0 5 / 01 / 2 019 <br />SCHEDULE <br />Name(s) Of Person(s) Or Organization(s): <br />ANY PERSON OR ORGANIZATION AGAINST WHOM <br />YOU HAVE AGREED TO WAIVE SUCH RIGHT OF <br />RECOVERY IN A WRITTEN CONTRACT OR <br />AGREEMENT. <br />Information required to complete this Schedule, if not shown above, will be shown in the Declarations. J <br />The Transfer Of Rights Of Recovery Against Others <br />To Us Condition does not apply to the person(s) or <br />organization(s) shown in the Schedule, but only to the <br />extent that subrogation is waived prior to the "accident" <br />or the 'loss" under a contract with that person or <br />organization. <br />REVIEWED & APPROVED <br />By Risk MAIVAGFMFNT DiVisiON <br />o T 0 9 2019 <br />FRANCINE R. VILLAREAL <br />CA 04 44 03 10 Copyright, Insurance Services Office, Inc., 2009 <br />Page 1 of 1 <br />
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