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�� of Amar�Sna„ Consuleingr,,,_I_LC ,_•_„,��« <br />Policy 5011 D86788 CA <br />6.18160-13 <br />(Ed, 11197) <br />WORKERS" COMPOM111014 AM EMPLOYERS° RIASILITY NSMANGE POLICY <br />KANKET WAIVER OF OUR RIGHT TO RECO:VER. FROM OTHERS <br />We mtdorsement chanes the patioy W wMah It Is aftaol%d <br />illsrood UO RATI Ons Wullrraa' Ca RpaneaUan lrmuranae Q. Reooaary From OWN and Pon TWO Emptayam' <br />Llabll>ly {neuri mn H. Recovery From OUw m are amended by adding thu following; <br />We wlN not enforce our sight W ranover agelnel pereana Or organfratfons, 71ts agresmani appltaa only to ft extant that <br />you podorin wotk under a wridton conftaot than raeulraayou toobtaht We ag(aamant Isom us.) <br />PREIt11UM CHAKQE- <br />Tha ohatgo WIN be an amoutt to whlahyou and wa agree that le a peroontago of the total slandard premium for California <br />expaautd, Tha amount Is <br />61•19160-B Page I of f <br />jEd,111d1) <br />aviEwI� <br />Say Nfargsrer Mercer ei 5,44 pm, Ocf 3n2017 <br />