CTR052593-RenewalWOS.pdf
PDF 168 KB Posted
- Attached to
- Master Agreement AZ|CTR052593
- Contract number
- CTR052593
- Issued by
- Arizona
About this file
This document is a Workers Compensation and Employers Liability Insurance Policy Endorsement issued by CopperPoint Indemnity Insurance Company for St. Mary's Food Bank Alliance, with an effective date of 07/01/2023. The policy specifically involves the State of Arizona, including its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees, and provides a waiver of the insurance company's right to recover payments from those named in the Schedule.
The endorsement is a Waiver of Right to Recover endorsement (WC 00 03 13), which applies to work performed by or on behalf of the contractor. The document indicates this is an insurance policy that provides coverage for workers compensation and employers liability, with the unique characteristic of preventing the insurance company from seeking recovery of payments from the specified Arizona state entities for losses arising from work performed under a written contract. The policy number is 1001987, with Endorsement No. 1, and was countersigned, though specific premium amounts are not disclosed in the visible document.
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Text version
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.
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.)
07/01/2023Endorsement Effective 1001987Policy No. 1Endorsement No.
St Mary's Food Bank AllianceInsured Premium $
CopperPoint Indemnity Insurance CompanyInsurance Company Countersigned by
This document may have been uploaded to the CopperPoint Portal.
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 State Blanket/Schedule/State
AZ State of Arizona. Its departments, agencies, boards, commissions, universities and its officers, officials, agents, and employees for losses arising from work performed by or on behalf of the contractor
File details come from the government source that posted it. Updated .