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WP0041690
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4200/4300 - Liquid Waste/Water Well Permits
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WP0041690
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Entry Properties
Last modified
4/14/2021 12:19:32 PM
Creation date
4/14/2021 10:26:22 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
WP0041690
PE
4371
STREET_NUMBER
0
Direction
E
STREET_NAME
MORADA
STREET_TYPE
LN
City
STOCKTON
Zip
95212-
APN
NEAR 08518041
ENTERED_DATE
2/9/2021 12:00:00 AM
SITE_LOCATION
0 E MORADA LN
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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EHD - Public
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Attachment Code: D545188 Certificate ID: 15495702 <br />Workers' Com ensatlon and Em lo ers Liability Polic <br />Named Insured <br />AEGION CORPORATION <br />17985 EDISON AVE <br />CHESTERFIELD MO 63005 <br />Endorsement Number <br />Policy Number <br />Symbol: WLR Number. WLRC67457262 (CA/MA) <br />Policy Period <br />7/1/2020 TO 7/1/2021 <br />Effective Date of Endorsement <br />07-01-2019 <br />Issued By (Name of Insurance Company) <br />ACE AMERICAN INSURANCE COMPANY <br />Insert the policy number. The remainder of the Information Is to be completed only when this endorsement Is Issued subsequent to the preparation of the <br />policy. <br />CALIFORNIA WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT <br />This endorsement applies only to the insurance provided by the policy because California is shown in Item 3.A. of <br />the Information Page. <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, but this waiver applies only with <br />respect to bodily injury arising out of the operations described in the Schedule, where you are required by a <br />written contract to obtain this waiver from us. <br />You must maintain payroll records accurately segregating the remuneration of your employees while engaged in <br />the work described in the Schedule. <br />Schedule <br />( ) Specific Waiver <br />Name of person or organization: <br />( X) Blanket Waiver <br />Any person or organization for whom the Named Insured has agreed by written contract to furnish this <br />waiver. <br />Operations: <br />ALL OPERATIONS CONDUCTED BY AN INSURED PURSUANT TO SUCH <br />WRITTEN CONTRACT <br />3, Premium: <br />The premium charge for this endorsement shall be 2.0 percent of the California premium developed <br />on payroll In connection with work performed for the above person(s) or organization(s) arising out of <br />the operations described. <br />4. Minimum Premium: $0 <br />Authorized Representative <br />WC 90 03 75 (05/18)
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