Laserfiche WebLink
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 42 03 04 B <br /> (Ed. 6-14) <br /> TEXAS WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT <br /> This endorsement applies only to the insurance provided by the policy because Texas is shown in Item 3.A. of the <br /> Information Page. <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, but this waiver applies only with respect to bodily <br /> injury arising out of the operations described in the Schedule where you are required by a written contract to obtain this <br /> waiver from us. <br /> This endorsement shall not operate directly or indirectly to benefit anyone not named in the Schedule. <br /> The premium for this endorsement is shown in the Schedule. <br /> Schedule <br /> 1. (❑) Specific Waiver <br /> Name of person or organization <br /> (❑) Blanket Waiver <br /> Any person or organization against whom you have agreed to waive your right of <br /> recovery in a written contract, provided such contract was executed prior to the <br /> date of loss. <br /> 2. Operations: <br /> 3. Premium: <br /> The premium charge for this endorsement shall be 2% percent of the premium developed on payroll in <br /> connection with work performed for the above person(s) or organization(s) arising out of the operations described. <br /> 4. Advance Premium: <br /> This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. <br /> (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) <br /> Endorsement Effective 09-30-25 Policy No. 71845146 Endorsement No. 001 <br /> Insured THUNDER TOPCO, LP Premium $ Incl . <br /> Insurance Company Chubb National Insurance Company <br /> Countersigned By <br /> WC 42 03 04 B <br /> (Ed. 6-14) <br /> ©Copyright 2014 National Council on Compensation Insurance,Inc.All Rights Reserved. <br /> Producer Copy <br />