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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICYWC 04 03 06 <br /> <br /> (Ed. 04-84) <br /> <br />WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENTCALIFORNIA <br /> <br /> <br />We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the <br />person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract <br />that requires you to obtain this agreement from us.) <br /> <br />You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the <br />Schedule. <br /> <br />such <br />remuneration. <br /> <br /> <br />Schedule <br /> <br />Person or Organization Job Description <br />Any person or organization with whom or with which you have agreed See wording under Person or Organization <br />in a written contract to waive your right of recovery against, provided <br />such written contract: <br /> <br /> <br /> <br />1. is currently in effect or will be come effective during the term <br /> of this policy; and <br />2. was executed and became effective prior to the occurrence <br /> of the injury covered by this policy. <br /> <br />This form only applies in CA. <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. <br /> <br /> <br />Endorsement Effective Policy No. 4087479726 Endorsement No. <br />Insured Insurance Company <br /> <br /> <br /> <br /> Countersigned By <br /> <br />