Laserfiche WebLink
5 <br /> WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC040306 <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 ofyour employees while engaged in <br /> the work described in the Schedule. <br /> The additional premium for this endorsement shall be 2% ofthe California workers' compensation premium <br /> otherwise due on such remuneration. <br /> SCHEDULE <br /> PERSON OR ORGANIZATION JOB DESCRIPTION <br /> ANY PERSON OR ORGANIZATION FOR WHOM THE BLANKET WAIVER OF SUBROGATION <br /> NAMED INSURED HAS AGREED BY WRITTEN <br /> CONTRACT TO FURNISH THIS WAIYER <br /> This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. <br /> (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) <br /> Endorsement Effective: 10/01/2024 Policy No. 7600024851241 Endorsement No. 001 <br /> Insured: Dominguez General Engineering, Inc. <br /> Premium $INCL. <br /> Insurance Company: Everest Premier Insurance Company <br /> Countersigned By: <br /> -1998 by the Workers' Compensation Insurance Rating Bureau of California.All rights reserved. <br /> From the WCIRB's California Workers' Compensation Insurance Forms Manual- 1999. <br />