CTR062834-WCWOS.pdf

This document is a Workers Compensation and Employers Liability Insurance Policy Endorsement, specifically a Waiver of Our Right to Recover from Others Endorsement, issued for the State of Arizona. The policy covers the State of Arizona, including its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees, with the policy number R2WC429239.

The endorsement relates to a job description of operating a homeless shelter, with a Class 8864 and a payroll subject to waiver of 162,000. The waiver premium is set at $250.00. The document outlines the insurance company's right to waive recovery of payments for injuries covered under the policy, specifically for the named organization performing work under a written contract. The endorsement is part of a workers' compensation insurance policy and provides specific protection for the state's activities related to homeless shelter operations.