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Bsblfmjbo!Foufsqsjtft-!Jod/ <br />SXE6111537191401203133 <br />1401203134 <br />WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICYWC 04 03 06 <br />(Ed. 04-84) <br />WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENTCALIFORNIA <br />Person or Organization <br />Job Description <br />(The information below is required only when this endorsement is issued subsequent to preparation of the policy.) <br />7 <br />WC 04 03 06Page 1 of 1 <br /> <br /> <br />