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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 2 % of the total California Workers' Compensation premium <br /> otherwise due. <br /> Schedule <br /> Person or Organization Job Description <br /> Any Person/Organization for whom the All California Operations <br /> Named Insured is required underwritten <br /> 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 05/12/2024 Policy No. WSD 5055233 04 Endorsement No. <br /> Insured CHAMBERS GROUP INC Premium $ INCL. <br /> Insurance Company INSURANCE COMPANY OF THE WEST <br /> Countersigned By RiekManageneneoMslon <br /> ( � REviEWEo&APPROv®BY: <br /> : <br /> kftijAlft tia4144 <br /> WC 99 06 34 ' Risk Mutagement specOnst <br /> (Ed. 8-00) <br />