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 fo ll owing "att aching clause" need be completed only when th is endorsemen t is issued subsequent to preparation of the policy). <br />This endorsement , effective 12:01 AM 04/01/2024 forms a part of Policy No . WC 025-89-3658 <br />Issued to JMB CONSTRUCT I ON, I NC. <br />By NEW HAMPSH I RE I NSURANCE COMPANY <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 />Countersigned by __________________ ~~~ ~ ~~ <br />Authorized Representative <br />DocuSign Envelope ID: 7FAA54C3-9A1A-4C50-9AAD-7467E7B73787