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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 <br />_ (Ed. 4x64) <br />WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT—CALIFORNIA <br />We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce <br />our right against the person or organization named in the Schedule, (This agreement applies only to the extent that <br />you perform work under a written contract that requires you to obtain this agreement from us,) <br />You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the <br />work described in the Schedule. <br />The additional premium for this endorsement shall be LU —% of the California workers' compensation premium <br />otherwise due on such remuneration, <br />Schedule <br />Person or Organization Job Description <br />Blanket Waiver- Any person or organization for whom the All CA Operations <br />Named Insured has agreed by written contact to famish this <br />walver. <br />This endorsement changes the policy to which It Is attached and Is effective on the date issued unless otherwise stated. <br />(rhe Information below is required only when this endorsement is issued subsequent to preparation of the policy,) <br />Endorsement Effective Policy No. VgWC881714 Endorsement No, <br />Insured Insurance Company <br />Countersigned By <br />©1398 by the wonters' Compensation Insurance Rating Bureau of California. All rights reserved. <br />