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WORXERS C0011131SATION <br />TRAVELERS] - AND <br />ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY <br />HARTFORD CT 06183 ENDORSEMENT WC"63 76 ( A) - ooi <br />POLICY UB-7K72867624-43-G <br />WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS <br />ENDORSEMENT-CALIFORN <br />(BLANKET WAIVER) <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. <br />The additional premium for this endorsement shall be 2. 00 <br />mium . <br />Schedule <br />Person orOrganlzatlon <br />ANY PERSON OR ORGANJ. ZATIO FOR <br />WHICH THE 1NBQRED RAS AGREED <br />BY WRITTEN CONTRACT EBECU1111ro <br />PRIOR TO LOSS TO FURNJ:SH TRIS <br />i0►IVER . <br />% of the California workers' compensation pre - <br />Job Description <br />This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise <br />stated. <br />(The information below is required only when this endorsement is issued subsequent to preparation of <br />the pollcy.) <br />Endorsement Effective <br />Insured <br />Insurance Company <br />Policy No. <br />DATE OF ISSUE:07/01/2024 ST ASSIGN: <br />Endorsement No. <br />Premium <br />RAMougementDMsian <br />% REVIEWED & APPROVED BY: <br />R tlfaN44 <br />— Risk Management Specialist <br />