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fIl:�% 9 /I01:ly <br />WORKERS COMPENSATION <br />AND <br />EMPLOYERS LIABILITY POLICY <br />ENDORSEMENT WC 99 03 76 (00) <br />POLICY NUMBER: TC2JUB-4245B22-A-10 <br />WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS <br />ENDORSEMENT - CALIFORNIA <br />(BLANKET WAIVER) <br />We have the right to recover our payments from anyone liable for an injury covered by this policy. <br />We will not enforce our right against the person or organization named in the Schedule. <br />You must maintain payroll records accurately segregating the remuneration of your employees while <br />engaged in the work described in the Schedule. <br />The additional premium for this endorsement shall be % of the California workers' compensation <br />premium otherwise due on such remuneration. <br />Schedule <br />Person or Organization <br />ANY PERSON OR ORGANIZATION <br />FOR WHOM THE NAMED INSURED <br />HAS AGREED BY WRITTEN <br />CONTRACT EXECUTED PRIOR TO <br />LOSS TO FURNISH THIS WAIVER. <br />Job Description <br />Miscellaneous Attachment: M100686 <br />Certificate ID : 10886430 <br />