Laserfiche WebLink
TRAVELERSJw <br />ONE TOWER SQUARE <br />HARTFORD CT 06183 <br />WORKERS COMPENSATION <br />AND <br />EMPLOYERS LIABILITY POLICY <br />ENDORSEMENT WC 00 03 13 (00) - 001 <br />POLICY NUMBER: US-2Y352892-24-42-G <br />WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT <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. (This agreement applies only to the <br />extent that you perform work under a written contract that requires you to obtain this agreement from us.) <br />This agreement shall not operate directly or indirectly to benefit any one not named in the Schedule. <br />SCHEDULE <br />DESIGNATED PERSON: <br />DESIGNATED ORGANIZATION: <br />ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED <br />BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS <br />WAIVER. <br />RleltMan tDw[un <br />REVIEWED&APPROVEDSr <br />A� Acava�fo <br />_91�wm_ Risk Management Specialist <br />01 <br />DATE OF ISSUE: 04-19-24 ST ASSIGN: PAGE 1 OF <br />197-1y3i. 242d M, 3'0 <br />ne EL Gdhriel s I S/L]/•934 x C21 .2 , Ieael I Fag- 9 ,,. o <br />'1'tie ati iicnte a el rc =gyp=rs=d=r, 9 L acc lr ieaee, c_rt i-i cat=_s. <br />