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Pacific Plumbing Company of Santa Ana <br />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 % of the California workers' compensation premium <br />otherwise due on such remuneration. <br />Schedule <br />Person or Organization <br />Person or Organization: Any person or <br />organization for whom the Named Insured has <br />agreed by written contract to furnish a waiver <br />provided you executed the contract before the <br />loss. <br />Issued by Scottsdale Insurance Company A+ <br />For attachment to Policy No. WC2Z91471456620 Effective Date 3/1/2020 <br />WC 04 03 06 <br />Ed. 0411984 <br />Job Description <br />Any <br />Premium <br />REvievED 6 APPROVED BY.' <br />Fug 2. vit""! <br />Risk Management Analyst <br />57000381 1 20/21 GL/An/OMB/WC/POLL I A Ptte R ro 1 8/13/2020 7:30:57 AM (PDT) I Page 14 of 14y �I <br />