Laserfiche WebLink
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 3 %of the total California Workers' Compensation premium <br /> otherwise due. <br /> Schedule <br /> Person or Organization Job Description <br /> ANY PERSON OR ALL CALIFORNIA <br /> ORGANIZATION FOR OPERATIONS, <br /> WHICH THIS WAIVER <br /> IS REQUIRED. <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 7/112024 Policy No. WSD 5056095 04 Endorsement No. <br /> Insured TSCM Corp Premium $ INCL. <br /> Insurance Company INSURANCE COMPANY OF THE WEST <br /> Counterslgned By <br /> WC 99 06 34 <br /> (Ed. 8-00) <br /> INSURED <br /> 8382a8D3 1 2025 PKG + 2024 WC I Sara 1,ee 12/4/2025 91M 37 AM (PST) I Page 1C of 14 <br />