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Policy Number: PSWO003626 <br />WORKERS CumPL-N8ATO0AND EMPLOYERS UAB|L|TYINSURANCE POLICY YyGD4U30O <br />(Ed.4-U^g <br />WAIVER OF OUR RIGHT T{)RECOVER FROM OTHERS ENDORSEMENT—CALIFORNIA <br />We have the right to recover our payments from anyone liable for an injury covered by this pdicy, We will not enforce <br />our right against the person or organization named in the Schedu|e� (This agreement applies only tothe extent that <br />you perform work under a written contract that requires you to obtain this agreement from us) <br />You must maintain payroll records accurately segregating the rern uneration of your employees while engaged ill. tile <br />wokdeaucibnd.in the Schedule, <br />Tile additional premium For this endorsement shall be _2.% of the California workers' compensation prernium <br />otherwise due onuuubremuneration, <br />pu/vpvw,{)nywoizuUvn <br />All persons ororganizations that are party to <br />contract 'that nequine�syou toobtain this <br />ogmnmcnt,pmvidodyou oxooutod thoonnhom <br />before, the.loss, <br />Schedule <br />JvUovvt;,ipUm/ <br />Jobs performed for any person or o rganization 'that you <br />have agreed with inawritten contract toprovide this <br />ogmomon'. <br />This endorsernerit changes the policy In which It is attoched and is effedive or) the date issued unless oihewjsvxtjted, <br />(The information below Is required an ly when this a riclorsann grit I" Issued SUbspquent to proparation of the pal icy.) <br />snuomomo'emecu*, pm*ywu Endnrsennentwo. <br />Insured Insurance cG=lpany <br />RL| insurance Company <br />Countersigned By <br />@1998 by the Workers' Compenratlon Insurance Rating Bureou of California. All rights reserved. <br />