Okaloosa County BOCC — August 19, 2014 — Certificate of Insurance — reading text

entiorsement is attachad. CA Gt OF 02 66 THY S0-17698-03 GU 12) 40-33-32 PAGE 001 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us. This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule Schedule All persons or organization that are parties to a contract that require you to obtain this agreement, provided you executed the contract before the loss occurred. This endorsement is executed by the Sentry Insurance a Mutual Company Premium $ Effective Date: 10/1/2013 Expiration Date 10/1/2014 For attachment to Policy No. 90-17698-01 Countersigned by Authorized Representative WC 00 03 13 Page 1 of 1 Ed. 09/30/2000 IL SU 4004 (10-10) HDI-GERLING AMERICA INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION AMENDMENT SCHEDULE Name, Address and E-Mail Address of Other Number of Days Notice: Person(s) / Organization(s): When required by prior written contract 30 Days On File with Company (If no entry appears above, the information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) |. If we cancel this policy by notice to you for any statutorily permitted reason other than nonpayment of premium, we shall endeavor to mail, e-mail or deliver a copy of such written notice of cancellation to the person(s) or organization(s) shown in the Schedule above. I. A copy of the notice, per paragraph lL. above, will be mailed, e-mailed or delivered: 1. To the appropriate addresses corresponding to the person(s) or organization(s) shown in the Schedule above; and 2. The number of days required for notice of cancellation, as provided in paragraph A.2. of the Common Policy Conditions or as amended by an applicable state cancellation endorsement or by the date as shown in the Schedule above. Il. Our failure to provide such advance notification to the person(s) or organization(s) shown in the Schedule of this endorsement will not extend any policy cancellation date nor negate any cancellation of the policy. All other terms and conditions of this policy remain unchanged. Page 1 of 1 IL SU 4004 (10-10)