Laserfiche WebLink
CNAWorkers Compensation And Employers Liability Insurance <br />We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not <br />enforce our right against the person or organization named in the Schedule. <br />This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. <br />Schedule <br />Any Person or Organization on whose behalf you are required to obtain this waiver of our right to recover <br />from under a written contract or agreement. <br />The premium charge for the endorsement is reflected in the Schedule of Operations. <br />All other terms and conditions of the policy remain unchanged. <br />This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers, <br />takes effect on the Policy Effective Date of said policy at the hour stated in said policy, unless another <br />effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy <br />unless another expiration date is shown below. <br />Form No: WC 00 03 13 (04-1984) P <br />Endorsement Effective Date: Endorsement Expiration Date: E <br />Endorsement No: 5; Page: 1 of 1 P <br />Underwriting Company: Valley Forge Insurance Company, 151 N Franklin St, <br />Chicago, IL 60606 <br />Copyright 1983 National Council on Compensation Insurance, <br />Risk Mmageme t DMe(un <br />����� [REVIEWED&(AP'PIR�O(V/ED BYE: <br />�itY1.11:eYJ.'i f IN4iV.�.i�! Fes. VaGrfAP/fr. <br />AMORWO. R[sk Management Analyst <br />