Laserfiche WebLink
BLANKET WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT <br />This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different <br />date is indicated below. <br />(The following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy). <br />This endorsement, effective 12:01 AM 11 / 22 / 2023 <br />Issued to MOFFATT & NI CHOL <br />forms a part of Policy No. WC19397907 <br />By NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA. <br />We have a right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce <br />our right against any person or organization with whom you have a written contract that requires you to obtain this <br />agreement from us, as regards any work you perform for such person or organization. <br />The additional premium for this endorsement shall be 2. 00 % of the total estimated workers compensation premium <br />for this policy. <br />WC 04 03 61 <br />(Ed. 11/90) <br />Authorized Representative <br />Docusign Envelope ID: 8550A2C1-7DD2-41A8-96F8-EF3D050DCCEB