Press Alt + R to read the document text or Alt + P to download or print.
This document contains no pages.
HomeMy WebLinkAboutC87-025 Hartford hold harmless and release of liabilityHOLD HARMLESS AND RELEASE OF LIABILITY
TO: THE HARTFORD GROUP
Re: POLICYHOLDER: Eagle County
POLICY NUMBER: 34SR580252
POLICY PERIOD: -1/1/87-1/l/88
Washington Regional Office
100 North Pitt Street — P.O. Box 1414
Alexandria, Virginia 22313
Telephone: (703) 836-0222 -
R87_25_35
The undersigned officials of the above captioned Policyholder, hereby request
that The Hartford Insurance Company pay all benefits arising out of the claims
of the above captioned policy for the above -captioned policy period directly
to the above named Policyholder.
The undersigned officials hereby state that they have assumed financial
responsibility for any bills and expense.to the limit of liability to which
benefits have become payable under the above captioned policy. Payment
directly to the named Policyholder discharges The Hartford Insurance Company
of all liability under the above captioned policy to the extent of the
payments made.
Should any dispute arise over the payment of said claims to the Policyholder,
such organization will bear the financial responsibility of any duplicate
payment or request for payment which may arise. In the event of any legal
action brought against The Hartford Insurance Company in regard to any
payments made pursuant to this agreement, the above named Policyholder agrees
to bear all cpet--ip regard to that action.
This agre,dment mum be
SIGNED
SIGNED: G7w,
WITNESS:
gned by no less than two members of said Policyholder
i
DA
Hartford Fire Insurance Company and Its Affiliates
Hartford Plaza, Hartford, Connecticut 06115