Laserfiche WebLink
WORKER'S COMPENSATION / EMPLOYERS LIABILITY ENDORSEMENT <br /> ("The City") <br /> ATTN: <br /> A) POLICY INFORMATION Endorsement#: <br /> 1. Insurance Company ("The Company"): <br /> 2. Effective date of This Endorsement: <br /> 3. Named Insured: <br /> 4. Employer's Liability Limit (Coverage B): <br /> B) POLICY AMENDMENTS _ <br /> In consideration of the policy premium and not withstanding any inconsistent statement in <br /> the policy to which this endorsement is attached or any other endorsement attached thereto, <br /> it is agreed as follows: <br /> 1. Cancellation Notice. The insurance afforded by this policy shall not be suspended, <br /> voided, canceled, reduced in coverage or in limits except after thirty (30) days prior _ <br /> written notice by certified mail return receipt requested has been given to the City. Such <br /> notice shall be addressed as shown in the heading of this endorsement. <br /> 2. Waiver of Subrogation. The Insurance Company agrees to waive all rights of - <br /> its elected or appointed officers, officials, agents, and <br /> subrogation against the City, <br /> employees for losses paid under the terms of this policy which arise from work <br /> performed by the Named Insured for the City. <br /> C) SIGNATURE OF INSURER OR AUTHORIZED REPRESENTATIVE OF THE INSURER - <br /> 1 (print/type name), warrant that I have authority to bind <br /> the below listed insurance company and by my signature person do so bind this <br /> company. <br /> SIGNATURE OF AUTHORIZED REPRESENTATIVE <br /> (Original signature required on Endorsement furnished to the City) <br /> ORGANIZATION: TITLE: <br /> ADDRESS: TELEPHONE: <br /> Division IV-27 NEI Phase II Water and Sewer <br /> July 2007 CIP Nos.7468, 7589, 7590 <br />