Laserfiche WebLink
TRAVELERS` WORKERS COMPENSATION <br /> AND <br /> ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY <br /> HARTFORD CT 06183 <br /> ENDORSEMENT WC 99 03 76 ( A) - 001 <br /> POLICY NUMBER: UB-7J230124-24-14-G <br /> WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS <br /> ENDORSEMENT - CALIFORNIA <br /> (BLANKET WAIVER) <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 /> The additional premium for this endorsement shall be 2.00 % of the California workers' compensation pre- <br /> mium. <br /> Schedule <br /> Person or Organization Job Description <br /> ANY PERSON OR ORGANIZATION FOR <br /> WHICH THE INSURED HAS AGREED <br /> BY WRITTEN CONTRACT EXECUTED <br /> PRIOR TO LOSS TO FURNISH THIS <br /> WAIVER. <br /> INCLUDING: <br /> LOS ANGELES DEPT. OF WATER & <br /> POWER, RISK MANAGEMENT, RM. <br /> 465, 111 N. HOPE ST., LOS <br /> ANGELES, CA 90012 <br /> This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise <br /> stated. <br /> (The information below is required only when this endorsement is issued subsequent to preparation of <br /> the policy.) <br /> Endorsement Effective Policy No. Endorsement No. <br /> Insured <br /> a ort,�s Risk ManagementDivision <br /> REVIEWED&APPROVED BY: <br /> Insurance Company Countersigned by <br /> 1! • A4..p Acwado <br /> Risk Management Specialist <br /> DATE OF ISSUE: 08-02-24 ST ASSIGN: <br />