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Agmt24 Pizza My Heart, Inc. (831 Middlefield)
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Agmt24 Pizza My Heart, Inc. (831 Middlefield)
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Last modified
11/12/2024 1:50:50 PM
Creation date
11/12/2024 1:50:19 PM
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Agreement
PROJECT NAME
Outdoor Business Activity License Agreement_10.25.2024
RMP File Number
304.5
Date
10/25/2024
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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 <br />(Ed. 04-84) <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 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 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 />State <br />Person or Organization <br />Job Description <br />California <br />The City of Redwood City <br />All California operations <br />c/o Engineering Division <br />performed by the Named Insured <br />1017 Middlefield Road <br />on Behalf of the Certificate <br />Redwood City, CA 94061 <br />Holder. <br />The premium charge for this endorsement shall be $250. This charge will be billed at the final audit. <br />WC 00 03 13 <br />(Ed. 04-84) <br />© 1983 National Council on Compensation Insurance. <br />1 of 2 <br />
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