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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 0410 C <br /> (Ed.01-19) <br /> WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA <br /> BLANKET BASIS <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 you <br /> perform work under a written contract that requires you to obtain this agreement from us.) <br /> The additional premium for this endorsement shall be calculated by applying a factor of 2% to the total manual <br /> premium, with a minimum initial charge of$350, then applying all other pricing factors for the policy to this calculated <br /> charge to derive the final cost of this endorsement. <br /> This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. <br /> Schedule <br /> Blanket Waiver <br /> Person/Organization Blanket Waiver—Any person or organization for whom the Named Insured has <br /> agreed by written contract to furnish this waiver. <br /> Job Description Waiver Premium(prior to adjustments) <br /> All CA Operations 5936.00 <br /> This endorsement changes the policy to which it Is attached and Is effective on the date issued unless otherwise stated. <br /> (The information below is required only when this endorsement is issued subsequent to preparation of the pollcy.) <br /> Endorsement Effective: 0 5/1 212 0 2 5 PolicyNo.: SAWC666825 Endorsement No.: <br /> Insured; Premium$ <br /> Insurance Company: Berkshire Hathaway Homestate Ins Co <br /> Countersigned by <br /> WC 99 04 10 C <br /> (Ed,01-19) <br />