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<br />, " . <br /> <br />WORICEft8 COIoI'ENSATION AND EMPLOY1R8 UMlUlY INlUtANCI POUCY <br /> <br />we 1M OS 08 <br /> <br />WAIVER OF OUR RIGHT TO RECOVER FROM OnlERS ENDORSEMENT- <br />CALIFORNIA <br /> <br />WIl hM the right to recowtr our payments Irom ll'lyone IIbIe lor III Injury 0CMred by this policy. WI WIll not enlorce <br />our right lIIl8lnst the person or orgll1iD1ion nll1led In the Schedule. (This sgl1lllTl8flt lIIlP11e8 only to the exllnt th. <br />you perform work under a wrlt1lln oontrlCt th.It llIIlulrlla you to obllm thIS llQl"llllf1l from us.) <br /> <br />You must m8lnt8in payrolll1lOOrda acc:u..- segregaling the rwmunelWion of your ~Ioysee While enQIIlllId In the <br />work described In the Schedule. <br /> <br />The Idditional PIlIIl'lk.m lor thIS endo_nt shall be 5 <br />otherwise due on suCh IlIIl'l unet1tion. <br /> <br />% 01 the CIIInomla worlGlra' oompenlllltion pllIIl'llum <br /> <br />lICHIDULI <br /> <br />PIRSON OR ClRGANIZAll0N <br /> <br />.JOB DI8CRIP110N <br /> <br />..... uoou., n <br />CC8I'.l'UCr <br /> <br />Thle e~t Chsnges the poley to which ~ is sII&hed snd "~on the dl!M ~ un.. otherwile_. <br />(TIll ~........4..1 beIllIw Ia NqUhd _ when thIII......._. IaIleu8d ."'-'-n II>> pi' ~ ..... fillw...,.) <br /> <br />End... _,..nt Eff8cIIw 06-03-07 <br /> <br />Policy No. D272W00184 <br /> <br />EndoraMlent No. 001 <br />Plwnium $DICL. <br /> <br />In.u~ CROSSTOWN ELECTRICAL & DATA, INC, <br />InsursnOl Compsny DISCOVER PROPERTY & CASUALTY INSURANCE CO, <br />Counlertigned By <br /> <br />01_1IJ" _ Q,......_.... ......_...... _ oIClIIfamI. .......__. <br />!'ran" WC..w. e. ... WCW...... c..._........I_l'amw....... ,. <br /> <br />- <br />