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Policy Number: 59 WEAL3MXU <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />WAIVER OF OUR RIGHT TO RECOVER FROM <br />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 <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 of your employees while engaged in <br />the work described in the Schedule. <br />The additional premium for this endorsement shall be % of the California workers' compensation premium <br />otherwise due on such remuneration. <br />SCHEDULE <br />Person or Organization <br />Blanket where required by written contract. <br />Job Description <br />Countersigned by <br />Authorized Representative <br />Form WC 04 03 06 (1) Printed in U.S.A. <br />Process Date: Policy Expirat o G t w ue iaPRwms <br />T�n� 3eaa&t <br />�^'� g6k: rtnanagenent M�lyi[ <br />