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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 /> oR,N F RiskMougementDMsian <br /> WC 99 03 13 C ' ReMeWED&APPROVED BY. <br /> (Ed. 7-09) A-j. a Acev44 <br /> Risk Management Specialist <br />