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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 <br />_(Ed. 4.84) <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 -e)tent that <br />you perform work under a written oonlraot 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 prernlum for this endorsement shell be 2&% of the Callfomis workers' compensation premium <br />otherwise due on such remuneration. <br />Schedule <br />Portion or Organization Job Description <br />Blanket Waiver of Subrogation As respects to all CA jobs performed by the named <br />Insured during the policy period where by written contract <br />a waiver of aubrogation Is required prior to the <br />commencement of work. <br />This 6ndaaemenl olmos the Po9ay to wtddt his at aahad end is eBeWve on ace date laeued Wdem oeruuNe stated • <br />(rha information below Is required only when this endorsement to issued subequatd to prepuabon or the psaoy.) <br />EndareamentEttecd" 12.294MO Policy No. FTAa9295t}e3 Endomement No. <br />Insumnoe Coany <br />Past mpOOM, Ira. (A Corp) Falls Lake FIw a Cseuaky Comparry <br />Countereipned By <br />r 01998 by the Wa*eW campenaedon Irrwearwe aaang Bureau of CaWomla. An darts rasenm& <br />a`d% <br />