Orange County NC Website
Browse       Search
DocuSign Envelope ID: D81 132DAD-599E-4763-A300-356131341`41 E65 <br /> PINNA COL 7501 E Lowry Blvd <br /> ASSURANCE Denver, CO 80230-7006 <br /> 303-361-4000/800-873-7242 <br /> www.pinnacol.com <br /> NCCI#: WC000313B <br /> Policy#: 4060755 <br /> Clarion Associates LLC PFS Insurance Group, LLC -Johnstow <br /> 621 17th St Ste 2250 4848 Thompson Pkwy <br /> Denver, CO 80293 Suite 200 <br /> Johnstown, CO 80534 <br /> (970)635-9400 <br /> ENDORSEMENT: Blanket Waiver of Subrogation <br /> We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not <br /> enforce our right against the person or organization named in the Schedule. This agreement applies only to the <br /> extent that you perform work under a written contract that requires you to obtain this agreement from us. <br /> This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. <br /> SCHEDULE <br /> To any person or organization when agreed to under a written contract or agreement,as defined above <br /> and with the insured, which is in effect and executed prior to any loss. <br /> Effective Date:July 1,2014 Expires on:July 1, 2015 <br /> Pinnacoi Assurance has issued this endorsement July 2, 2014. <br /> Rodney Cole <br /> Underwriter <br /> 7501 E Lowry Blvd Denver,CO 80230-7006 <br /> Page 1 of 1 P ISA- 07/02/201419:26:16 4060755 41639092 359-8 <br />