CTR052635-RenewalInsuranceWOS.pdf

This document is a Workers Compensation and Employers Liability Insurance Policy Waiver of Right to Recover from Others Endorsement issued by CopperPoint Indemnity Insurance Company. The policy is specifically for the State of Arizona, encompassing its departments, agencies, boards, commissions, universities, and their respective officers, officials, agents, and employees. The endorsement is effective from 07/01/2023, with Policy No. 1001987 and Endorsement No. 1.

The endorsement details a waiver of subrogation rights, meaning the insurance company will not seek to recover payments from parties named in the Schedule, specifically the State of Arizona and its associated entities. The document indicates that this agreement applies only when work is performed under a written contract requiring such coverage, and it cannot be used to benefit parties not explicitly named in the Schedule. The policy is standard form WC 00 03 13 (Edition 4-84) and was published by the National Council on Compensation Insurance.