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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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BLANKET WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT <br />This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different <br />date is indicated below. <br />(The following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy). <br />This endorsement, effective 12:01 AM 10/03/2022 <br />Issued to ROADSAFE TRAFFIC SYSTEMS, INC. <br />By AIU INSURANCE COMPANY <br />forms a part of Policy No. WC 035901930 <br />We have a right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce <br />our right against any person or organization with whom you have a written contract that requires you to obtain this <br />agreement from us, as regards any work you perform for such person or organization. <br />The additional premium for this endorsement shall be 2 % of the total estimated workers compensation premium <br />for this policy. <br />WC 04 03 61 Countersigned by ____________________ <br />(Ed. 11190) <br />Authorized Representative <br />
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