AZ_WOKERS_COMPENSATION_WAIVER_OF_SUBROGATION.pdf
PDF 95 KB Posted
- Attached to
- Master Agreement AZ|CTR067443
- Contract number
- CTR067443
- Issued by
- Arizona
About this file
This document is a Workers Compensation and Employers Liability Insurance Policy Endorsement issued by Vigilant Insurance Company for Robbins Geller Rudman & Dowd LLP, with an effective date of 05-01-24. The endorsement specifically involves a Waiver of Right to Recover from Others, naming the State of Arizona, including its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees located at 3300 N Central Avenue, 14th Floor in Phoenix, AZ 85012.
The endorsement provides a waiver of subrogation, which means the insurance company agrees not to seek recovery of payments from the specified entities, but only to the extent that work is performed under a written contract requiring such an agreement. There are specific provisions noted for policies or exposures in Missouri, which limit the waiver's applicability to certain construction classifications. The policy number is 71839019, and the premium is listed as "Incl." (included), suggesting the cost is embedded within the overall insurance coverage.
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Text version
This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated.
(The information below is required only when this endorsement is issued subsequent to preparation of the policy.)
Endorsement Effective 05-01-24 Policy No. 71839019 Endorsement No.
Insured ROBBINS GELLER RUDMAN & DOWD LLP Premium $ Incl.
Insurance Company Vigilant Insurance Company
Countersigned By
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13
(Ed. 4-84)
WC 00 03 13
(Ed. 4-84)
1983 National Council on Compensation Insurance.
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT
We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.)
This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule.
Schedule
The State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees 3300 N Central Avenue, 14th Floor Phoenix, AZ 85012
For policies or exposure in Missouri:
Any person or organization for which the employer has agreed by written contract, executed prior to loss, may execute a waiver of subrogation. However, for purposes of work performed by the employer in Missouri, this waiver of subrogation does not apply to any construction group of classifications as designated by the waiver of right to recover from others (subrogation) rule in our manual.
Insured Copy
File details come from the government source that posted it. Updated .