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<br />. , ' . <br /> <br />WClRlCEft8 COIol'ENSATION AND EMPLDYlR8 UMlUTY IN8tIUNCI! POUCY <br /> <br />wc 0403 08 <br /> <br />WAIVER OF OUR RIGHTTO RECOVER FROM antERS ENDORSEMENT- <br />CALIFORNIA <br /> <br />Wt h_ the right to IlICO\I8l' our payments from ..yone IlIbIe for .. Injury ooWAld by this policy. WI will not enloroe <br />our right lIIll*lll the person or orgsnlDlion n8Tled In the Sdledule. (This Illrwnent lIPP"" only to the exlInt thlll <br />you perfonn work under a wrltlen conlrlCt thai rwqui.... you to oIltllln this agreamsnt from us.) <br /> <br />You mull m8ln1lim p~ rwc:orda 8CCUrIIIeIy ssgregaling the rwnunelllllon of your emplOyees while eng9d In the <br />work desorlbed In tt. ulll. <br /> <br />ThlI8ddltionlll premkm for this endor.-nent shlllllle 5 <br />ott.rwise due on such remuneration. <br /> <br />% 01 the C8IIIomIa work8nl' compenllltlon premium <br /> <br />SCHEDULE <br /> <br />PIR80N (II (IICWtiZAllON <br /> <br />.JOB IlII8CRIPnON <br /> <br />........ JmQUUlIID ft <br />~ <br /> <br />This endOrtll. leI1t chlll'lg88 the poloy to which ~ Is lIbchIId end Is ellllctI\II on the dlie iasuId unlHs otherwise 1lIIIId. <br />(The ~......6M beIaw Ie..... on/IJ"'" .........._..Ie Iseusd -"-<p.m III pr ~ T: '''''poIoJ.) <br /> <br />Endor.-nent Ellec:tlw 06-03-07 Policy No. D272W00184 EndCll1lllTl8llt No. 001 <br /> <br />Ineured CROSSTOWN ELECTRICAL & DATA, INC, <br />InsurenOl Compeny DISCOVER PROPERTY & CASUALTY INSURANCE CO, <br />Counlllrsigned By <br /> <br />Prwnium $DICL. <br /> <br />o t_Ily.._O"...... ".__...... _ oIClo1Iforrio. ,.......-. <br />I'nIIn .. we...... ('''",.iI> Wll.h.... c...._ ~ oft 1_1'onne lIsnuIIe 1l1lll1. <br /> <br />-. <br />