WC_-WoS.PDF
PDF 241 KB Posted
- Attached to
- Master Agreement AZ|CTR078623
- Contract number
- CTR078623
- Issued by
- Arizona
About this file
This document is a Workers Compensation and Employers Liability Insurance Policy endorsement related to a waiver of subrogation rights. The primary entity involved is the State of Arizona, specifically including its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees. The endorsement is associated with an insurance policy numbered TWC4504570, issued by an unspecified insurance company.
The endorsement appears to be a standard workers' compensation policy document that modifies the standard insurance agreement by preventing the insurance carrier from recovering payments from certain named parties. While the document does not provide specific details about contract amounts, services, or pricing, it represents a legal mechanism that limits the insurance company's right to pursue recovery of paid claims from the State of Arizona and its associated entities when work is performed under a specific written contract. The endorsement is dated with an edition of 4-84 and was developed by the National Council on Compensation Insurance.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| AI.PDF | ||
| COI_State_of_Arizona.pdf | ||
| WoS.PDF |
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
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)
1983 National Council on Compensation Insurance.
TWC4504570
The State of Arizona and its departments, agencies, boards, commissions, univerities, officers, officals, agents, and emaployees
File details come from the government source that posted it. Updated .