WC_WOS__1_.pdf
PDF 124 KB Posted
- Attached to
- Master Agreement AZ|CTR078005
- Contract number
- CTR078005
- 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 Midwest Family Mutual Insurance to Arizona Automotive Equipment, LLC. The policy involves The Arizona Department of Corrections, Rehabilitation & Reentry, The State of Arizona, and its various departments, agencies, boards, commissions, universities, officers, officials, agents, and employees. The policy number is CPAZ0560127181-5.
The endorsement specifically provides a waiver that prevents the insurance company from recovering payments from the named entities in the Schedule, which applies only when work is performed under a written contract requiring such an agreement. The document does not detail specific goods, services, pricing terms, or contract options. It is primarily a legal instrument that modifies the standard workers compensation insurance policy to provide additional protection for the State of Arizona and its associated entities by limiting the insurer's subrogation rights.
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Text version
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE
POLICY
WC 00 03 13
(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
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 Policy No. Endorsement No.
Insured Premium
Insurance Company Countersigned by _______________________________________________
WC 00 03 13
(Ed. 4-84)
Midwest Family Mutual Ins.
Arizona Automotive Equipment, LLC
CPAZ0560127181-5
The Arizona Department of Corrections, Rehabilitation & Reentry, The State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees.
File details come from the government source that posted it. Updated .