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TnWAMY,CWj.dty WORKERS COMPENSATION <br />AND <br />EMPLOYERS LIABILITY POLICY <br />ENDORSEMENT WC fig OS 76 (00) -- <br />Policy No: DTEUB5637L65011 <br />WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS <br />ENDORSEMENT - CALIFORNIA <br />(BLANKET WAIVER) <br />WA navahR right to mcnrvor nur paymontr from anyone Ifahla frw an jr1my noverad by this policy_ We will net <br />enforce our right against the person or organization named in the Schedule. <br />You must maintain payroll records accurately segregating the remuneration of your employees white engaged in <br />the work described in the Schedule. <br />The additional premium kx his endorsement shall be en of the California workers' compensation pre <br />mium otherwise due on such remuneration. <br />Schadulo <br />Person or Organization <br />Per Written Contract <br />DATE OF ISSUE: 08/15/11 STASSIGN: <br />Job Description <br />