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WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS <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 20/ 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 <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' <br />Issued to DMS Facility Services <br />Policy term 10-1-1 a to 10-1-19 <br />Policy # WA7-69D458727-068 <br />Effective Date <br />Job Description <br />Premium $ <br />WC 04 93 06 Page 1 of 1 <br />Ed: 04/1984 <br />