Orange County NC Website
Browse       Search
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 <br />(Ed.4-84) <br />WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT <br />We have the right to recover our payments from anyone liable for an injury covered by this policy.We will <br />not enforce our right against the person or organization named in the Schedule.(This agreement applies <br />only to the extent that you perform work under a written contract that requires you to obtain this agreement <br />from us.) <br />This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. <br />Schedule <br />All persons or organizations that,in a written contract executed by both parties prior to the <br />date of the injury covered by this policy,require you to obtain this agreement from us. <br />NOTE:This endorsement does not apply to any work completed at job sites located in Kentucky. <br />This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. <br />(The information below is required only when this endorsement is issued subsequent to preparation of the policy.) <br />Endorsement Effective 12-12-23 Policy No.WC0100063818-03 Endorsement kJ/. <br />Insured JETCLEAN AMERICA LLC Erbium $Ijzcl . <br />Insurance Company FCCI Insurance Company <br />Countersigned By / <br />WC 00 03 13 <br />(Ed.4-84) <br />©1983 National Council on Compensation Insurance. <br />Insured Copy <br />Docusign Envelope ID: 06AB3B5F-54E7-44B0-87A0-CF612E1799BB