CTR066188_-_WC_WOS__1_.pdf

This document is a Workers Compensation and Employers Liability Insurance Policy endorsement issued by Pennsylvania Manufacturers' Association Insurance Company, with PMA Ins Co as the WCIP Assigned Carrier (NCCI Carrier Code 11916). The policy is specifically for the State of Arizona, Department of Economic Security, located at 1789 West Jefferson St, Mail Drop 6271 in Phoenix, AZ 85007. The endorsement is for ALICE'S PLACE INC as the insured entity.

The document is a Waiver of Right to Recover from Others Endorsement, which modifies the existing insurance policy. The endorsement is effective from 08-19-24, with Policy No. WCAZ000093002 and Endorsement No. 003. The key feature of this document is that it limits the insurance company's right to recover payments from parties liable for an injury covered under the policy, with the agreement applying only to the extent of a written contract that requires obtaining a written agreement from the U.S. The premium for this endorsement is noted as "INCL." (included), suggesting no additional cost for this specific endorsement.