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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 0410 C <br /> (Ed. 01-19) <br /> WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA <br /> BLANKET BASIS <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 you <br /> perform work under a written contract that requires you to obtain this agreement from us.) <br /> The additional premium for this endorsement shall be calculated by applying a factor of 2% to the total manual <br /> premium, with a minimum initial charge of $350, then applying all other pricing factors for the policy to this calculated <br /> charge to derive the final cost of this endorsement. <br /> This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. <br /> Schedule <br /> Blanket Waiver <br /> Person/Organization Blanket Waiver —Any person or organization for whom the Named Insured has <br /> agreed by written contract to furnish this waiver. <br /> Job Description Waiver Premium (priortoadjustments) <br /> All CA Operations 415.00 <br /> This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. <br /> (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) <br /> Endorsement Effective: 08/31/2024 PolicyNo.: TOWC532707 Endorsement No.: <br /> Insured: Premium$ <br /> Insurance Company: Oak River Insurance Company " RiakMougennentDMsin <br /> P Y P Y — Gf , REVIEWED&APPROVED BY: <br /> s,� <br /> Countersigned by_ �� Risk Management Specialist <br /> WC990410C <br /> (Ed. 01-19) <br />