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02
City of Pleasanton
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CITY CLERK
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AGENDA PACKETS
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2009
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031709
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02
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Last modified
3/11/2009 3:44:04 PM
Creation date
3/11/2009 3:34:25 PM
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CITY CLERK
CITY CLERK - TYPE
STAFF REPORTS
DOCUMENT DATE
3/17/2009
DESTRUCT DATE
15 Y
DOCUMENT NO
02
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' WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY <br />WC 440.906 <br />WAIVER OF OUR RIGHTTO RECOVER FROM OTHERS ENDORSEMENT- <br />CALIFORNIA <br />We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce <br />our right against the person or organization named in the Schedule. (This agreement applies only to the extent that <br />you perform work under a written contract that requires you lo. obtain this agreement from us.) <br />You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the <br />work described in the Schedule. <br />The additional premium for this endorsement shall be <br />otherwise due on such remuneration. <br />PERSON OR ORGANIZATION <br />BLANKET WAIVER <br />of the California workers' compensation premium <br />SCHEDULE <br />JOB DESCRIPTION <br />BLANKET WAIVER <br />- 1998 by the Workers' Compensation Insurance Paling Bureau of California. All rights reserved. <br />Prom the WCIRB's California Workers' Compensation Insurance Forms Manual -1999. <br />
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