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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 <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 you <br /> 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 otherwise <br /> due on such remuneration. <br /> SCHEDULE <br /> PERSON OR ORGANIZATION JOB DESCRIPTION <br /> ANY PERSON OR ORGANIZATION FOR WHOM YOU ARE BLANKET WAIVER OF <br /> REQUIRED BY WRITTEN CONTRACT OR AGREEMENT SUBROGATION <br /> TO <br /> OBTAIN THIS WAIVER OF RIGHT FROM US PRIOR TO <br /> INJURY. <br /> ©1998 by the Workers'Compensation Insurance Rating Bureau of California. All rights reserved. <br /> From the WCIRB's California Workers'Compensation Insurance Forms Manual© '1999. <br /> INSURED COPY <br />