Laserfiche WebLink
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />WAIVER OF OUR RIGHT TO RECOVER FROM <br />OTHERS ENDORSEMENT - CALIFORNIA <br />Policy Number: 57 WEC AU9LTU Endorsement Number: 001 <br />Effective Date: 08/19/25 Effective hour is the same as stated on the Information Page of the policy. <br />Named Insured and Address: Ali Ahmad <br />2053 BROADWAY ST STE B <br />REDWOOD CITY CA 94063 <br />We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our <br />right against the person or organization named in the Schedule. (This agreement applies only to the extent that you <br />perform work under a written contract that requires you to obtain this agreement from us.) <br />You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work <br />described in the Schedule. <br />The additional premium for this endorsement shall be 5 % of the California workers' compensation premium otherwise due <br />on such remuneration. <br />SCHEDULE <br />Person or Organization <br />The City of Redwood City its Council, officers, officials, <br />agents, employees, and Volunteers, 1017 MIDDLEFIELD <br />RD, REDWOOD CITY, CA, 94063 <br />Countersigned by <br />Job Description <br />Authorized Representative <br />Form WC 04 03 06 (1) Printed in U.S.A. <br />Process Date: 08/19/25 Policy Expiration Date: 11/08/25 <br />