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contributing to any insurance issued <br /> in the name of the City <br /> Waiver of subrogation from Worker's <br /> Compensation Insurer <br /> This certificate is issued as a matter of information This certificate is not an <br /> ' insurance policy and does not amend, extend or alter the coverage afforded by <br /> the policies listed herein Not withstanding any requirement, term or condition of <br /> any contract or other document with respect to which this certificate of insurance <br /> may be issued or may pertain, the insurance afforded by the policies described <br /> herein is subject to all the terms, exclusions and conditions of such policies <br /> ' Agency or Brokerage Insurance Company <br /> ' Address Home Office <br /> MName of Person to be Contacted Authorized Signature <br /> Telephone Number Date <br /> NOTE Authorized signature may be the agent's if agent <br /> has placed insurance through an agency <br /> agreement with the insurer If insurance is <br /> brokered, authorized signature must be that of an <br /> official of insurer <br /> August 2001 Division IV-37 Ball Park& Park & Ride Wells Ph 1 <br />