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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 34 <br />(Ed. 8-00) <br />WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - BLANKET <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 />The additional premium for this endorsement shall be <br />otherwise due. <br />Person or Organization <br />ANY <br />PERSON/ORGANIZATION <br />FOR WHOM THE NAMED <br />INSURED IS REQUIRED <br />UNDER WRITTEN <br />CONTRACT TO FURNISH <br />THIS WAIVER. <br />2 % of the total California Workers' Compensation premium <br />Schedule <br />Job Description <br />ALL CALIFORNIA <br />OPERATIONS <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 05/12/2023 Policy No. WVE 5055233 03 <br />Insured CHAMBERS GROUP INC <br />Insurance Company INSURANCE COMPANY OF THE WEST <br />WC 99 06 34 <br />(Ed. 8.00) <br />Countersigned By <br />Endorsement No. <br />Premium $ INCL. <br />Plait tragane„ t um� <br />RWEWM&APPRovmBy. <br />�. A+g:a Aavd. <br />® Risk Management Specialist <br />INSURE) <br />INSURE) <br />