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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 34 <br />WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - BLANKET <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 />The additional prentium for this endorsement shall be <br />otherwise due. <br />Person or Organization <br />ANY PERSON / ORG <br />WHEN REQUIRED BY <br />WRITTEN CONTRACT <br />3 % of the total California Workers' Compensation premium <br />Schedule <br />Job Description <br />ALL CA OPERATIONS <br />This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. <br />(The Infomelion below is required only when this endorsement is issued subsequent to preparation of the Policy.) <br />Endorsement Effective 06/03/2021 PolicyNo,WVF 5030354 06 <br />Insured CROSSTOWN ELECTRICAL & DATA <br />Insurance Company INSURANCE COMPANY OF THE WEST <br />Countersign4l By _ <br />WC 99 06 34 <br />(Ed.&W) <br />N,4 REO <br />Endorsement No. <br />Premum $ INCL. <br />RA MvugmwdDiv I= <br />Rtvie &APPROVDST. <br />® Risk Management Analyst <br />