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Last modified
10/14/2019 4:12:14 PM
Creation date
10/10/2019 4:26:14 PM
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Contracts
Company Name
STANBRIDGE UNIVERSITY
Contract #
N-2019-199
Agency
PARKS, RECREATION, & COMMUNITY SERVICES
Expiration Date
9/16/2020
Insurance Exp Date
4/6/2020
Destruction Year
2025
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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 <br />(Ed 4-84) <br />WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA <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 <br />you perform work under a written contract that requires you to obtain this agreement from us.) <br />You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the <br />work described in the Schedule. <br />The additional premium for this endorsement shall be 2_5% of the California workers' compensation premium <br />otherwise due on such remuneration. <br />Schedule <br />Person or Organization Job Description <br />Blanket Waiver of Subrogation As respects to all CA jobs performed by the named insured <br />during the policy period where by written contract a waiver <br />of subrogation is required prior to the commencement of <br />work. <br />This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise staled <br />(The information below Is required only when this endorsement is issued subsequent to preparation of the policy.) <br />Endorsement Effective 04-06-2019 Policy No. FLA011415-00 Endorsement No. <br />Insured Insurance Company <br />Stanbridge University, Inc. (a Corp) Falls Lake Fire & Casualty Company <br />Countersigned By <br />01998 by the Workers' compensation Insurance Rating Bureau of California. All rights reserved. REVIEWED & APPROVED <br />By RISk MANAGEMENT DIVISION <br />�-- <br />FRANCINE R. VILLAREAL <br />
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