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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 <br />(Ed. 4.84) <br />NiAIVER OF OUR RIGHT TO RECOVER PROM OTHERS ENDORSEMRNT- CALIFORNIA <br />We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce <br />Our right against the person or organization nerved in the Schedule. (This agreement applies only to the extent that <br />you perform work under a written contract that requires you to obtain this agreement from tea.) <br />You must maltil payroll records accurately segregating the remuneration or your employees while engaged in the <br />work described in the Screws. <br />The additional premium for this endorsement shall be ? Vo of the California workers' compensation premium <br />otherwise due on such remuneration, <br />Sollodute <br />Person or Organization Job Description <br />- For Proposal Purposes • Nate: Non- Jobs performed for any person or organization that you <br />specific terms such as agents, volunteers, have agreed with in a written contrast to provide this <br />subaldlariea, rpprasentatives, sucoasaors and agreement. <br />Thte ondoremnsnt changes the Policy townich It Is attechod and Is offecllve of lho date (saved unless other✓rlsa stated. <br />(The Informallon ])view Is rogphisf hnlywhsn Ihts endorsement is lashed eutlen rani to propnrailun of the Polley.) <br />andwsencont Effective 1013112013 PwlcyNa PSWO001282 <br />tannish Insolence company <br />Joseph C. Truxaw and Associates, Inc. RLI Insurance Company <br />Counterslgned By <br />E ndorse nolnn No. <br />OI U98 by ti's worsen' Compensation Insurance Ronne Bureau of ClI fmnla, Alt rights reserved, <br />WA, .u"'/ Ti un 40/1 B /LPL1 11 .j 1� . 'x" 5 of i <br />25E -41 <br />