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Waiver of Subrogation Request Letter and Sample Wording

This is a broker request letter, not an insurer endorsement or a legal release. A form downloaded from this page cannot add a waiver to an insurance policy.

Download the original TXT template

How to use it

Identify the policies and contract provisions that require the waiver.
Give the broker the beneficiary names, work scope and dates. Ask whether blanket wording applies or a scheduled endorsement is needed.
Obtain the actual policy evidence and review its effective date, conditions and applicable state rules before accepting the request as resolved.

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Vendor and projectAgent nameVendor legal nameProject and work scopeRequired coverage typesExact legal entity namesSigned agreement and relevant sectionDates and locationReview email or upload linkReview deadlineSender name

Subject: Waiver of subrogation evidence request — [Vendor and project]

Hi [Agent name],
Our agreement with [Vendor legal name] for [Project and work scope] requires waiver of subrogation evidence for [Required coverage types].

Requested beneficiary: [Exact legal entity names]
Contract reference: [Signed agreement and relevant section]
Work dates / location: [Dates and location]

Please confirm whether the applicable policies can meet this requirement and provide the relevant waiver endorsement or other appropriate policy evidence. If relying on a blanket endorsement, please identify its conditions and confirm what contract documentation is needed.

Please identify any restriction, exception, effective-date issue or additional approval needed. Do not add certificate wording that the policy does not support.

Send documents to [Review email or upload link] by [Review deadline].
[Sender name]

Example in practice

A vendor has a blanket GL waiver but the contract also asks for a workers comp waiver. Request and review evidence for each policy separately; the GL document does not establish the workers comp position.

Only the policy and applicable endorsement terms determine insurance waiver scope. A certificate statement, contract clause or this request letter does not by itself amend those terms.