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WORkERS'COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY <br />I i WC 99 06 34 <br />(Ed, 8-00) <br />WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - BLANKET <br />We have fhe right to recover our payments from anyone liable for an injury covered by this policy, We t not enforce <br />our right against the person or organization named In the Schedule. (This agreement apn wplies only to the Vol(xtent that <br />You perronork under a written contract that requires you to obtain this agreement from e <br />The additional premium for this endorsement shall be 3 % of the total California Workers' Compensatl�n premium <br />'otherwise due. <br />I <br />Schedule <br />Person or Organization Job 17escrlption I <br />ANY PERSON / ORC ALL CA OPERATIONS <br />WHEN REQUIRED BY <br />WRITTEN CONTRACT 1 <br />i <br />This endorsement changes the Palley to which It Is attached and Is effective on the date issued unless otherwise stated. <br />(The Information below is required only when this endorsement is Issued subsequent to preparation of t G policy.) <br />Endorsement Effective 08/13/2019 Policy No. WSA 5037498 02 <br />Endorsement No <br />Insured V21LEY MAINTENANCE CORPORATION <br />Premium $ IqCL . <br />Insurance f;ompany INSURANCE COMPANY OF THE WEST <br />s <br />Countersigned ey <br />WC 99 06 3' <br />(Ed.. gnu) BEV! <br />QED & APPROVED <br />Y Risk Mn�vn��iwa,vr Di i' <br />FRANC R. V1L1AREgt <br />