WC_WOS_St_of_AZ_-__CTR052635.PDF
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- Attached to
- Master Agreement AZ|CTR052635
- Contract number
- CTR052635
- Issued by
- Arizona
About this file
This document is a Workers Compensation and Employers Liability Insurance Policy Endorsement for the State of Arizona, specifically a Waiver of Right to Recover document. The jurisdictional coverage encompasses multiple Arizona-based entities including BNSF Railway Co., Jones Lang LaSalle Brokerage, Lowe Enterprises, Arizona Generator Technology, Arizona Western College, Sysco Corporation, City of Phoenix Human Services Department, and the State of Arizona itself, along with its departments, agencies, boards, commissions, and universities.
The policy, issued by CopperPoint Indemnity Insurance Company, is effective from 07/01/2022 with policy number 1001987. The endorsement provides a blanket waiver that prevents the insurance company from pursuing recovery payments from the named organizations for work-related injury claims, but only to the extent that work is performed under a written contract requiring such an agreement. The document specifically protects the listed entities from subrogation efforts, ensuring comprehensive workers' compensation coverage across various Arizona-based organizational contexts.
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Text version
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13
(Ed. 4-84)
WC 00 03 13
(Ed. 4-84)
© 1983 National Council on Compensation Insurance.
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 Blanket/Schedule/State
AZ BNSF Railway Co., Jones Lang LaSalle Brokerage, Inc. 4200 Buckingham Rd., Ste. 110
AZ Lowe Enterprises, Inc. PO Box 100085 - LE
AZ Arizona Generator Technology, Inc. dba GEN-TECH. 7901 N. 70th Ave.
AZ Arizona Western College. PO Box 929
AZ BNSF Railway Co. ATTN: Director Leases and Permits. 2301 Lou Menk Dr., GOB-3W
AZ Sysco Corporation. Its Subsidiaries, Affiliates and Divisions. 1390 Enclave Parkway
AZ City of Phoenix, Human Services Dept. 200 West Washington St., 18th Floor
AZ State of Arizona. Its departments, agencies, boards, commissions, universities and its officers, officials, agents, and employees for losses arising from work performed by or on behalf of the Contractor
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.)
07/01/2022Endorsement Effective 1001987Policy No. 4Endorsement No.
St Mary's Food Bank AllianceInsured Premium $
CopperPoint Indemnity Insurance CompanyInsurance Company Countersigned by
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File details come from the government source that posted it. Updated .