Orange County NC Website
Named Insured <br />MOBILE MINI, INC. <br />4646 E. VAN BUREN STREET <br />PHOENIX , AZ 85008 <br />Endorsement Number <br />Policy Number <br />Symbol: WLR Number· C67814964 <br />Policy Period <br />11-01-2020 TO 11-01-2021 <br />Effective Date of Endorsement <br />11-01-2020 <br />Issued By (Name of Insurance Company) <br />ACE AMERICAN INSURANCE COMPANY <br />Insert the policy number. The remainder of the i nformation is to be completed only when this endorsement is issued su bse q uent to the prep arati on of the policy. <br /> <br />TEXAS WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT <br />This endorsement applies only to the insurance provided by the policy because Texas is shown in item 3.A. of the <br />Information Page . <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, but this waiver applies only with respect <br />to bodily injury arising out of the operations described in the Schedule , where you are required by a written contract <br />to obtain this waiver from us. <br />This endorsement shall not operate directly or indirectly to benefit anyone not named in the Schedule. <br />The premium for this endorsement is shown in the schedule . <br />Schedule <br />1. Specific Waiver <br />Name of person or organization : <br /> <br /> <br /> <br />( X ) Blanket Waiver <br />Any person or organization for whom the Named Insured has agreed by written contract to <br />furnish this waiver. <br />2. Operations: <br />ALL TEX AS OPERATIONS <br /> <br /> <br /> <br /> <br /> <br />3. Premium: <br />The premium charge for this endorsement shall be 2 • 0 percent of the premium developed on <br />payroll in connection with work performed for the above person(s) or organization(s) arising out of the <br />operations described . <br />4. Advance Premium: <br /> <br /> <br /> <br /> <br />wc 42 03 04B (06/14) © Copyright 2014 NationalCouncil on Compensati on Insurance, Inc.A ll Rights Reserved . <br />11-01-2021 TO 11-01-2022 11-01-2021 <br />C68929507 <br />DocuSign Envelope ID: F8EBDA2B-E1C9-4C03-80ED-E37FE36A5811