Orange County NC Website
Browse       Search
40 <br /> Workers' Compensation and Employers' Liability Policy <br /> Named Insured Endorsement Number <br /> VCO PARENT, LLC <br /> 5501 VIRGINIA WAY Policy Number <br /> SUITE 120 Symbol: RWC Number: (25)7183-47-94 <br /> Policy Period Effective Date of Endorsement <br /> 09-15-2024 TO 09-15-2025 09-15-2024 <br /> Issued By(Name of Insurance Company) <br /> ACE AMERICAN INSURANCE COMPANY <br /> Insert the policy number.The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. <br /> This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. <br /> ALTERNATE EMPLOYER ENDORSEMENT <br /> This endorsement applies only with respect to bodily injury to your employees while in the course of special or <br /> temporary employment by the alternate employer in the state named in Item 2 of the Schedule. Part One (Workers <br /> Compensation Insurance) and Part Two (Employers Liability Insurance) will apply as though the alternate employer <br /> is insured. If an entry is shown in Item 3 of the Schedule the insurance afforded by this endorsement applies only to <br /> work you perform under the contract or at the project named in the Schedule. <br /> Under Part One (Workers Compensation Insurance) we will reimburse the alternate employer for the benefits <br /> required by the workers compensation law if we are not permitted to pay the benefits directly to the persons entitled <br /> to them. <br /> The insurance afforded by this endorsement is not intended to satisfy the alternate employer's duty to secure its <br /> obligations under the workers compensation law. We will not file evidence of this insurance on behalf of the <br /> alternate employer with any government agency. <br /> We will not ask any other insurer of the alternate employer to share with us a loss covered by this endorsement. <br /> Premium will be charged for your employees while in the course of special or temporary employment by the <br /> alternate employer. <br /> The policy may be canceled according to its terms without sending notice to the alternate employer. <br /> Part Four (Your Duties If Injury Occurs) applies to you and the alternate employer. The alternate employer will <br /> recognize our right to defend under Parts One and Two and our right to inspect under Part Six. <br /> Schedule <br /> 1. Alternate Employer Address <br /> 2. State of Special or Temporary Employment <br /> 3. Contract or Project <br /> ANY PERSON OR ORGANIZATION TO WHOM OR TO WHICH YOU ARE <br /> REQUIRED TO ADD AS AN ALTERNATE EMPLOYER IN A WRITTEN <br /> CONTRACT OR WRITTEN AGREEMENT EXECUTED PRIOR TO LOSS, <br /> EXCEPT WHERE SUCH CONTRACT OR AGREEMENT IS PROHIBITED BY <br /> LAW. <br /> This endorsement is not applicable in the states of AK, HI, MI, OK and TX. <br /> WC 00 03 01A (Ed. 2-89) ©Copyright 1984, 1988 National Council on Compensation Insurance, Inc. All Rights Reserved. <br />