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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—CALIFORNIA <br /> We have the right to recover our payments from anyone liable for an injury covered by this policy.We will not enforce our right against <br /> the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written <br /> 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 work described in <br /> the Schedule. <br /> The additional premium for this endorsement shall be 2.5%of the California workers'compensation premium otherwise due on such <br /> remuneration. <br /> Schedule <br /> Person or Organization Job Description <br /> Any Person or Organization As Required by Written Contract. <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 0 1/2 712 02 5 Policy No. CWCO2822901 Endorsement No. 1 <br /> Insured CABIFORNIA ING Premium $2,568 <br /> Insurance Company: Clear Spring Property and Casualty Company Countersigned by: <br />