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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 <br />(Ed. 4-84) <br />Tilt r �� �� t r�i i i i► �ll 1i�AFileTZIMT-11 <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 extent that <br />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 the <br />work described in the Schedule. <br />The additional premium for this endorsement shall be 225% of the California workers' compensation premium <br />otherwise due on such remuneration, <br />Schedule <br />Person 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 subrogation is required prior to the <br />commencement of work. <br />This endorsement changes the policy to which It Is attached and is effective on the date issued unless otherwise slated <br />(The Information betow is required only when this endorsement is Issued subsequent to preparation of the policy.l <br />Endorsement Effective 12-29-2020 Policy No. FLA002950-04 Endorsement No. <br />Insured Insurance Company <br />Pest Options, Inc. (A Carp) Falls Lake Fire & Casually Company <br />Countersigned By <br />@1998 by the Workers' Compensation Insurance Rating Bureau of California.. All rights reserved. <br />o , os. a Rbk MVVOMIWIDMI1m <br />REVIEW® & ArrRmw Sr. <br />��' �1 %au �sen4acs <br />MEW Risk Mamgem tClenr l/aide <br />