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POLICY#WCC349857A <br /> WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 <br /> (Ed. 04-84) <br /> WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - <br /> CALIFORNIA <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 /> You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the <br /> work described in the Schedule. <br /> The additional premium for this endorsement shall be 2 % of the California workers' compensation premium <br /> otherwise due on such remuneration. <br /> SCHEDULE <br /> PERSON OR ORGANIZATION JOB DESCRIPTION <br /> ANY PERSON(S) OR ORGANIZATION(S) <br /> WITH WHOM YOU HAVE AGREED TO SUCH <br /> WAIVER, IN A VALID WRITTEN CONTRACT <br /> OR WRITTEN AGREEMENT THAT HAS BEEN <br /> EXECUTED PRIOR TO LOSS <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 04-11-25 Policy No.WCC349857A Endorsement No. <br /> Insured AESCO INC Premium $ INCL. <br /> Insurance Company NATIONAL CASUALTY COMPANY <br /> Countersigned By <br /> ©1998 by the Workers'Compensation Insurance Rating Bureau of California. All rights reserved. <br /> From the WC1RB's California Workers'Compensation Insurance Forms Manual a 1999. <br /> Insured Copy <br />