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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 04 10A (Ed 07-07) <br />WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT -CALIFORNIA <br />BLANKET BASIS <br />We have the right to recover our payments from anyone liable for an injury covered by this policy, We will not enforce our <br />right against the person or organization named in the Schedule. (This agreement applies only to the extent that you <br />perform work under a written contract that requires you to obtain this agreement from us.) <br />The additional premium for this endorsement shall be 2,00 % of the total policy premium otherwise due on such <br />remuneration. <br />The minimum premium for this endorsement is $ 3Fn on <br />Schedule <br />Person or Organization Job Description <br />ALL ORGANIZATIONS FOR WHOM THE WAIVER OF SUBROGATION IS ALL CALIFORNIA OPERATIONS <br />ISSUED <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 1214/15 Policy No. CSWC608754 <br />Insured CSG CONSULTANTS, INC. Premium $ ' <br />Insurance Company Berkshire Hathaway Homestate Insurance Company 0 <br />WC 99 04 10A <br />(Ed 07-07) <br />