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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC ON 04 WS A <br /> (Ed.01.19) <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 <br /> against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work <br /> 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 work <br /> described in the Schedule, <br /> Blanket Waiver: The additional premium for this endorsement shall be 2%of the California workers'compensation premium <br /> otherwise due on such remuneration. <br /> Specific Waiver:The additional premium for this endorsement shall be 5% of the California workers'compensation premium <br /> otherwise due on such remuneration. <br /> Schedule <br /> Person or Organization Job Description <br /> Blanket Waiver of Subrogation As respects to all CA jobs performed by the named insured <br /> during the policy period where by written contract a waiver of <br /> subrogation is required prior to the commencement of work. <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 07/01/2025 Policy No. ONCC13081-04 Endorsement No. <br /> Insured Insurance Company Omaha National Casualty Company <br /> Lawrence W.Rosine Co. <br /> Countersigned By <br /> I <br />