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M <br /> WORKER'S COMPENSATIONIEMPLOYERS LIABILITY ENDORESMENT <br /> ("the City") <br /> ATTN: <br /> Endorsement# <br /> A) POLICY INFORMATION <br /> i. Insurance company ("the Company") <br /> 2 . Effective date of This Endorsement <br /> .3 . Named Insured i <br /> 4. Employer's Liability Limit (Coverage B) <br /> B) POLICY AMENDMENTS <br /> In consideration of the policy premium and not withstanding any inconsistent <br /> statement in the policy to which this endorsement is attached or any other <br /> endorsement attached thereto, it.is agreed as follows: <br /> 1. Cancellation Notice. The insurance afforded by this policy shall not be <br /> suspended, voided, canceled, reduced in coverage or in limits except after <br /> i thirty (30) days prior written notice by certified mail return receipt requested <br /> has been given to the City. Such notice shall be addressed as shown in the <br /> heading of this endorsement. <br /> r <br /> 2 . Waiver of Subrogation. The Insurance Company agrees to waive all rights of <br /> subrogation against the City, its elected or appointed officers, officials, <br /> agents, and employees for losses paid under the terms of this policy which <br /> ' arise from work performed by the Named Insured for the City. <br /> C) SIGNATURE OF INSURER OR AUTHORIZED REPRESENTATIVE OF THE <br /> ' INSURER: <br /> i. (print/type name), warrant that I have authority <br /> to bind the below listed insurance company and by my signature person do <br /> so bind this company. <br /> 14 SIGNATURE OF AUTHORIZED REPRESENTATIVE <br /> (original signature required on <br /> endorsement furnished to the City) <br /> ORGANIZATION: TITLE: <br /> ADDRESS: TELEPHONE: ( <br /> DIVISION IV,-30 <br /> 1 <br />{ <br />