Laserfiche WebLink
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - <br />CALIFORNIA <br />We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not <br />enforce our right against the person or organization named in the Schedule. (This agreement applies only to the <br />extent that 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 <br />the work described in the Schedule. <br />The additional premium for this endorsement shall be 211% of the California workers' compensation premium <br />otherwise due on such remuneration. <br />Schedule <br />Additional premium is a percent of the California Manual Workers Compensation premium. Subject to a minimum <br />premium charge of $ 250 <br />Person or Organization Jab Descrption <br />Where required by contract or <br />written agreement prior to loss and <br />allowed by law. <br />Issued by Liberty Insurance Corporation 21814 <br />For attachment to Policy Effective Date Premium $ <br />Issued to DMS Facility Services <br />Policy term 10-1-19 to 10-1-20 <br />Work Comp Policy #WA7-69D458727-069 <br />dC04 o4/1 3 D6 By R+ k WED & APPROVED Page 1 of 1 <br />o )0 7 T <br />FRANCINE R. VILLAREAL <br />