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MGT of America, Inc Policy 8011086788 • GA <br />lZi 1:1 <br />WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE- POLICY <br />01LANKGT A men OF Oun niQHT To RI_coyaR FRom OTHERS <br />This endorsement changes the policy to which It Is attached, <br />G -11916" <br />(Ed. I IM7) <br />It is agread that Part One Workera' Compensation Insurance Q. Recovery From Others and Part Two Employers' <br />Liabliiiy Imuranos H. Recovery From Others are amended by adding the following; <br />We will not enforce our right to recover against persons or organizations. (This agreement applies only to the extent that <br />you perform work under a written contmcithat requires you to obtain this agreement from us.) <br />PREMIUM CHARGE - <br />The charge will be an amount to which you and we agree that Is a percentage of the total standard premium for California <br />exposure, The amount Is <br />G- 19160 -8 <br />(Ed, 1 1157) <br />�vt"`S. <br />✓ °„ ° t �atv N loll <br />A.,sistrri� <br />