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WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT — <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 2.0% 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 Oreanization Job Description <br />Where required by contract or written Any <br />agreement prior to loss and allowed by law. <br />Issued by Cc 2 - First Liberty Insurance Corp. REVIEWED & APPROVE[ <br />For attachment to Policy No. WC6-Z91-454286.039 By Risk MANAGCMC.N1 DIVISION premium $ <br />Effective Date 09/28/2019 <br />FE 6 020 <br />WC 04 03 06 <br />Ed. 04/1984 <br />�-n �ji e g u>rw-ems <br />