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TRAVELER WORKERS COMPENSATION <br /> AND <br /> Olm Tawss swwtf EMPLOYERS LIABILITY POLICY <br /> HARTFORD, OT 06103 <br /> ENDORSEMENT WC 99 03 76( A)— 001 <br /> POLICY NUMBER: UB2RU0190124430 <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. We will not <br /> e4orce our rlght against the person or organization named in the Schedule. <br /> The additional premium for this endorsement shall be 01,00 % of the California workers'componsation pre- <br /> mlum, <br /> Schedule <br /> Person or Organization Job Description <br /> ANY PERSON OR 04GANIZATION AS R12,QUIRRI)13Y'WIUTTEN CONTRACT <br /> F'AH WHICH THE IXSUREn HAS <br /> AGREED DX WRITTtO dpx;TR14 T <br /> 'EXECUTED PRIOR TO LOSS TO <br /> FURNISH THIS WAIVER. <br /> This endorsement changes the policy to which it is attached and is effective on the date Issued unless otherwise <br /> stated, <br /> (The information below is required only when this endorsement Is issued subsequent to preparation of <br /> the policy) <br /> Endorsement Effective 091 15/2024 Policy No,UI32RAD 19012443C Endorsement No. <br /> InsuredOUTDCUR DIMENSIONS,LLC Premium <br /> Insurance Company TRAYI-A.R1 s PROV CAS CO 01-AMER Countersigned by <br /> DATE OF ISSUE: ST ASSIGN: Page 1 of 1 <br />