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MARK THOMAS AND COMPANY A-2015-173 REVIEWED BY: <br />EUNICE HEREDIA (PG 5 OF 8) <br />WORKERS COMPENSATION <br />AND <br />EMPLOYERS LIABILITY POLICY <br />ENDORSEMENT WC 99 03 76 (A) POLICY <br />NUMBER:UB4342T25014 <br />WAIVER OF OUR RIGHT TO RECOVER FROM <br />OTHERS ENDORSEMENT CALIFORNIA <br />(BLANKET WAIVER) <br />We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right <br />against the person or organization named in, the Schedule. <br />The additional premium for this endorsement shall be <br />mium. <br />Person or Organization: <br />ANY PERSON OR ORGANIZATION FOR <br />WHICH THE INSURED HAS AGREED <br />BY WRITTEN CONTRACT EXECUTED <br />PRIOR TO LOSS TO FURNISH <br />THIS WAIVER, <br />% of the California workers' compensation pre - <br />Schedule <br />Job Description <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 09-15-2015 Policy No. UB4342T25015 Endorsement No. <br />insured: Mark Thomas & Company, Inc. Premium <br />Insurance Company Countersigned by <br />DATE OF ISSUE: ST ASSIGN: <br />