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G-19160-B <br />CNA Policy#7015145409 (Ed.11/97) <br />WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY <br />BLANKET WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS <br />This endorsement changes the policy to which it is attached. <br />It is agreed that Part One Workers' Compensation Insurance G. Recovery From Others and Part Two Employers' <br />Liability Insurance H. Recovery From Others are amended by adding the following: <br />We will not enforce our right to recover against persons or organizations. (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 />PREMIUM CHARGE - <br />The charge will be an amount to which you and we agree that is a percentage of the total standard premium for California <br />exposure. The amount is <br />%roe.„gyp Rlek MnuganmtDlWdwt <br />\� REVIEWED 6 APPROVED SP <br />G-19160-B Fu"`^'"` R. V: vad <br />(Ed. 11/97) Risk Managem nt Analyst <br />