VerdeValleyHomelessCoalition-WCWOS.pdf

This document is a Workers Compensation and Employers Liability Insurance Policy Endorsement, specifically a Waiver of Right to Recover from Others Endorsement, issued for the State of Arizona. The policy involves the state and its various departments, agencies, boards, commissions, universities, officers, officials, agents, and employees, with a specific focus on activities related to operating a homeless shelter. The document is associated with Policy No. R2WC429239 and involves Class 8864 in the state of Arizona.

The endorsement covers a payroll subject to waiver of $162,000 and includes a waiver premium of $250.00. The key purpose of this document is to provide a specific waiver that allows the insurance provider to waive their right to recover payments from the named organization for injuries covered under the policy. The waiver is limited to work performed under a written contract and is not intended to benefit any parties not explicitly named in the Schedule. The endorsement is effective on the date of issue and is part of a workers compensation insurance policy.