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Permits & Development - Encroachment(EP)/Driveway(DW) Permits - 2023_PS-2302001 thru PS-2302500_ - PS-2302003
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Permits & Development - Encroachment(EP)/Driveway(DW) Permits - 2023_PS-2302001 thru PS-2302500_ - PS-2302003
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Last modified
11/8/2023 9:14:35 AM
Creation date
11/8/2023 9:11:47 AM
Metadata
Fields
Template:
Permits_Development
DocName
PS-2302003
Category07
Encroachment(EP)/Driveway(DW) Permits
Year2
2023
Notes2
Roth Rd. E/O Lathrop City Limits
Address
PO Box 1270, Verdi,NV 89439
Application
Roadsafe Traffic System-UPRR
Type
Traffic Control Devices
Supplemental fields
Cross Ref
PWP7110005
Type (2)
Encroachment Permit (EP)
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WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT <br />This endorsement changes the policy to which it is attached effective on inception date of the policy unless a <br />different date is indicated below. <br />(The following " attaching clause" need be completed only when this endorsement is issued subsequent to <br />preparation of the policy). <br />This endorsement, effective 12:01 AM 10/03/2022 forms a part of <br />Policy No. WC 0359-01-929 Issued to ROADSAFE TRAFFIC SYSTEMS, INC <br />By AIU INSURANCE COMPANY <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 />Any Person or Organization with whom you have entered into a contract, a condition of which <br />requires you to obtain this waiver from us. This endorsement does not apply to benefits or damages paid <br />or claimed: <br />1. Pursuant to the Workers' Compensation or Employers' Liability Laws of Kentucky, New Hampshire, or <br />New Jersey; or <br />2. Because of Injury Occurring before you entered into such a contract. <br />This form is not applicable in California, Kentucky, New Hampshire, New Jersey, North Dakota, Ohio, Tennessee, <br />Texas, Utah, or Washington. <br />WC 00 03 13 Countersigned by (Ed. 04/84) <br />Authorized Representative <br />
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