Liability & Insurance

Sample Form 3: Waiver of Transfer of Rights of Recovery against Others to Us

Transfer of Rights of Recovery -This is another term for "waiver of subrogation"
Name of Person or Organization -This cannot be left blank. It must have our name or the “as required by contract” language.
The important language is highlighted -

TRANSFER OF RIGHTS OF RECOVERY

We waive any right of recovery we may have against the person or organization shown in the Schedule above

This waiver applies only to the person or organization shown in the Schedule above.

Contact Information

Jamie Bloom, Insurance Manager

Katie MacKay, Liability Manager

Risk Management Division

Human Resources Department

Business Hours
Monday – Friday
8:00 AM – 5:00 PM
Contact us by Phone
Address
575 Administration Drive
Room 116 B
Santa Rosa, CA 95403
38.465237, -122.725363

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