Laserfiche WebLink
Attachment Code: D587581 Master TD: 1491 108, Certificate ID: 17506716 <br />[a]\F-11 <br />UTAH WAIVER OF SUBROGATION ENDORSEMENT <br />This endorsement applies only to the insurance provided by the policy because Utah is <br />shown in Item 3.A. of the Information Page. <br />We have the right to recover our payments from anyone liable for an injury covered by <br />this policy. We will not enforce our right against the person or organization named in the <br />Schedule. (This agreement applies only to the extent that you perform work under a <br />written contract that requires you to obtain this agreement from us.) <br />This agreement shall not operate directly or indirectly to benefit anyone not named in <br />the Schedule. Our waiver of rights does not release your employees' rights against third <br />parties and does not release our authority as trustee of claims against third parties. <br />Schedule <br />Any person or organization against whom you have agreed to waive such right of <br />recovery in a written contract or agreement <br />All other terms and conditions of the policy remain unchanged. <br />:his endorsement, which forms a part of and is for attachment to the policy issued by the <br />designated Insurers, takes effect on the Policy Effective date of said policy at the hour <br />stated in said policy, unless another effective date (the Endorsement Effective Date) is <br />shown below, and expires concurrently with said policy unless another expiration date is <br />shown below. <br />Form No: WC 43 03 05 (07-2000) <br />Endorsement Effective Date: 05/01 /2021 <br />Policy No. 7014842824 <br />�w cF 1uAnwagmedDMsiun <br />Jy/\'x REVIEWED & APPROVED BY.- <br />V"° <br />--� RFsk janagement Analyst <br />