CTR066209_-_WC_WOS.pdf

This document is a Workers Compensation and Employers Liability Insurance Policy Waiver of Right to Recover from Others Endorsement for the State of Arizona. The policy involves the State of Arizona, its departments, agencies, boards, commissions, universities, officers, officials, and employees, with Berkshire Hathaway Homestate Ins Co as the insurance company. The endorsement is effective 03/01/2024 and has a policy number of WEWC519890.

The endorsement specifically details a waiver agreement where the insurance company will not enforce recovery rights against persons or organizations performing work under a written contract. The document covers work-related injuries for the State of Arizona, with a class code of 8864 for the state of Arizona (AZ). The waiver premium is listed as NA (not applicable), and the payroll subject to waiver is also marked as NA. The document is designed to provide workers compensation coverage with a specific waiver provision for the state and its associated entities.