CTR072891_-_WC_WOS__1_.pdf
PDF 146 KB Posted
- Attached to
- Master Agreement AZ|CTR072891
- Contract number
- CTR072891
- Issued by
- Arizona
About this file
This document is a Workers Compensation and Employers Liability Insurance Policy Endorsement for a Waiver of Right to Recover from Others, issued by Travelers Property and Casualty Association for A1 Transit LLC. The policy is specifically in favor of the State of Arizona, Department of Economic Security, and covers losses arising from work performed by or on behalf of the Contractor under Contract No. CTR072891.
The endorsement is effective 10-04-24 with Policy No. UB A3694196, and includes a waiver that prevents the insurance company from enforcing recovery rights against the State of Arizona and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees. The premium is listed as "INCL." (included), and the document is marked as Endorsement No. 001, indicating it may be part of a broader insurance or contract arrangement.
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Text version
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 0313
(Ed. 4-84)
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 OF ARIZONA
DEPARTMENT OF ECONOMIC SECURITY
In favor of the State of Arizona and its departments, agencies, boards, commissions, universities, officers, officials, agents and employees for losses arising from work performed by or on behalf of the Contractor.
CONTRACT NO: CTR072891
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.)
Endorsement Effective 10-04-24 Policy No. UB A3694196 Insured A1 Transit LLC
Endorsement No. 001
Premium $ INCL.
Insurance Company TRAVELERS PROPERTY AND CACUALTY ' ASSOCIATIO i�
Countersigned By tJ"'.:o'�
WC 00 0313
(Ed. 4-84) © 1983 National Council on Compensation Insurance.
AGENCY COPY
| Canyon Certificate of Insurance (4) |
| Canyon Certificate of Insurance |
| Canyon Taxi Additional Insured CGL |
| Canyon Taxi Auto Additional Insured Endorsement |
| Canyon Taxi Endorsement Form |
| Canyon Taxi L.L.C. Auto of Waiver of Subrogation |
| Canyon Taxi L.L.C. Waiver of Subrogation Endorsement |
| Canyon Taxi L.L.C. DES Contract #CTR060075 |
| Canyon Taxi LLC Certificate of Insurance |
| Canyon Taxi Waiver of Rights CGL |
| Canyon Taxi Workers Comp Certificate |
| Canyon Taxi Workers Comp Endorsement |
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