CTR077300 Kearl Workers Comp Waiver.pdf

This document is an insurance policy endorsement issued by Trumbull Insurance Company for Kearl LLC, located in Gilbert, Arizona. The policy (number 76 WEG BT5MF0) is effective from 06/11/25 to 06/11/26, with The Hartford as the service center. The endorsement includes the State of Arizona and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees as part of a waiver of subrogation provision.

The endorsement modifies the existing insurance policy by adding a Waiver of Our Right to Recover from Others Endorsement and amending policy forms WC990006B(1P) and WC000313. The document indicates that while this is not a bill, any premium changes will be reflected in the next billing statement. The policy appears to be a workers' compensation or business insurance policy that provides coverage for Kearl LLC, with specific provisions that limit the insurance company's right to seek recovery from certain parties, particularly the State of Arizona and its associated entities.