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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 03 13 C <br />(Ed. 7-09) <br />WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT — CALIFORNIA <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 />You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the <br />work described in the Schedule. <br />The additional premium for this endorsement shall be $ 500. <br />Schedule <br />Person or Organization Description <br />Any person or organization for whom the Named Insured has agreed by <br />written contract to furnish this waiver. <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 10/01/2023 Policy No. CW WCP 100061376 02 Endorsement No. <br />Insured DIVERSIFIED WATERSCAPES INC Premium: $0 <br />Insurance Company COMPWEST INSURANCE Countersigned by <br />COMPANY <br />WC990313C <br />(Ed. 7-09) <br />oR,N F RiskMougementDMsian <br />o <br />REVIEWED & APPROVED BY. <br />A-j�e Aczv44 <br />Risk Management Specialist <br />