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Y WORKERS COMPENSATION <br />AND <br />EMPLOYERS LIABQJTY POLICY <br />ENDORSEMENT WC 09 03 76 (00) — <br />Policy No: DTEUBS637L65011 <br />WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS <br />ENDORSEMENT - CALIFORNIA <br />(BLANKET WAIVER) <br />We navy .t a right to recover nur payments trom anynne liable far an injury rnvered by this policy_ We oNN not <br />enforce our right against the person or organization named in the Schedule. <br />You must maintain payroll records accurately sogregsling the remuneration of your employees white engaged in <br />the work described in the Schedule. <br />the additional premium br this endorsement shall be % of the Caitfotnis workers' compensation pre- <br />mium otherwise due on suoh remuneration. <br />Schedule <br />Person or OrparYzatlon <br />Per Written Contract <br />DATE OF ISSUE: 08/15/11 ST ASSIGN: <br />Jolt Description <br />