Laserfiche WebLink
ENDORSEMENT AGREEMENT <br />WAIVER OF SUBROGATION <br />BLANKET BASIS <br />HOME OFFICE <br />SAN FRANCISCO EFFECTIVE OCTOBER 1, 2024 AT 12.01 A.M. <br />ALL EFFECTIVE DATES ARE AND EXPIRING OCTOBER 1, 2025 AT 12.01 A.M. <br />AT 12:01 AM PACIFIC <br />STANDARD TIME OR THE <br />TIME INDICATED AT <br />PACIFIC STANDARD TIME <br />AASCSC <br />850 N BIRCH ST <br />SANTA ANA, CA 92701 <br />WE HAVE THE RIGHT TO RECOVER OUR PAYMENTS FROM ANYONE <br />LIABLE FOR AN INJURY COVERED BY THIS POLICY. WE WILL <br />NOT ENFORCE OUR RIGHT AGAINST THE PERSON OR <br />ORGANIZATION NAMED IN THE SCHEDULE. <br />THIS AGREEMENT APPLIES ONLY TO THE EXTENT THAT YOU <br />PERFORM WORK UNDER A WRITTEN CONTRACT THAT REQUIRES YOU <br />TO OBTAIN THIS AGREEMENT FROM US. <br />THE ADDITIONAL PREMIUM FOR THIS ENDORSEMENT SHALL BE <br />2.00% OF THE TOTAL POLICY PREMIUM. <br />SCHEDULE <br />PERSON OR ORGANIZATION JOB DESCRIPTION <br />ANY PERSON OR ORGANIZATION BLANKET WAIVER OF <br />FOR WHOM THE NAMED INSURED SUBROGATION <br />HAS AGREED BY WRITTEN <br />CONTRACT TO FURNISH THIS <br />WAIVER <br />9100741-24 <br />RENEWAL <br />NA <br />1-81-08-39 <br />PAGE 1 OF <br />APPROVED <br />By Cynthia Mora at 10:35 am, Dec 10, 2024 <br />NOTHING IN THIS ENDORSEMENT SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND <br />ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY <br />OTHER THAN AS ABOVE STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE <br />HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR <br />LIMITATIONS IN THIS ENDORSEMENT. <br />1 <br />COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: <br />OCTOBER 2, 2024 <br />:yam//7//� <br />2572 AUTHORIZED REPRESENT IVE PRESIDENT AND CEO <br />SCIF FORM 10217 (REV.4-2018) OLD DP 217 <br />