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WP0042720
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4200/4300 - Liquid Waste/Water Well Permits
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WP0042720
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Entry Properties
Last modified
6/27/2022 11:14:24 AM
Creation date
6/27/2022 11:06:23 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
WP0042720
PE
4372
STREET_NUMBER
142
STREET_NAME
INDUSTRIAL
STREET_TYPE
AVE
City
RIPON
Zip
95366-
APN
25939010
ENTERED_DATE
11/3/2021 12:00:00 AM
SITE_LOCATION
142 INDUSTRIAL AVE
P_LOCATION
05
P_DISTRICT
004
QC Status
Approved
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SJGOV\tsok
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EHD - Public
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CNA Workers Compensation And Employers Liability Insurance <br />Policy Endorsement <br />BLANKET <br />WAIVER OF <br />OUR RIGHT <br />TO RECOVER <br />FROM <br />OTHERS <br />This endorsement changes the policy to which it is attached. <br />It is agreed that Part One - Workers' Compensation Insurance G. Recovery From Others and Part Two - <br />Employers' Liability Insurance H. Recovery From Others are amended by adding the following: <br />We will not enforce our right to recover against persons or organizations. (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 />PREMIUM CHARGE - Refer to the Schedule of Operations <br />The charge will be an amount to which you and we agree that is a percentage of the total standard premium for <br />California exposure. The amount is 2%. <br />All other terms and conditions of the policy remain unchanged. <br />This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers, <br />takes effect on the Policy Effective Date of said policy at the hour stated in said policy, unless another <br />effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy <br />unless another expiration date is shown below. <br />Form No: G-1 9160-B (11-1997) <br />Policy No: WC 5 85648142 <br />Policy Effective Date: 11 /29/2020 <br />Endorsement No: 2; Page: 1 of 1 <br />Underwriting Company: National Fire Insurance Company of Hartford, 151 N Franklin St, Chicago, IL <br />60606 <br />0 Copyright CNA All Rights Reserved. <br />
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