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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 34 <br />(Ed. 8.00) <br />WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT • BLANKET <br />We have the right to recover our payments from anyone liable for an injury covered by this policy, We wil not enforce <br />our right against the person or organization named in the Schedule. (This agreement applies only to the xtent that <br />you perform work under a written contract that requires you to obtain this agreement from us), <br />The additional premium For this endorsement shall be <br />otherwise due. <br />Person or Organization <br />ANY PERSON / ORG <br />WHEN REQUIRED BY <br />WRITTEN CONTRACT <br />3 % of the total California Workers' Compensatil' n premium <br />Schedule <br />Job Description <br />ALL CA OPERATIONS <br />This endorsement changes the policy to which it is attached and is effective on the date issued unless otherllwlse stated. <br />(The Inf6mration below is required only when this endorsement is issued subsequent to preparation of thie policy.) <br />Endorsement Effective 08/13/2019 Policy No. WSA 5037498 02 Endorsement Na,i <br />Insured V-XLLEY MAINTENANCE CORPORATION Premium $ IgCL. <br />Insurance 0ompany INSURANCE COMPANY OF THE WEST <br />Countersigned By <br />WC 99 06 34 <br />(Ed, a-oo) REVIEWED & APPROVED <br />w,sen+ r> By Risk MAWIEMENT DiViq <br />ON <br />OCT- <br />FRANC E R, VILL4REAiL <br />