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This endorsement is issued by the company named on the Information Page. It forms a part of the policy as of the effective <br />date, at the hour stated on the Information Page. <br />This endorsement changes the insurance as is afforded by the policy relating to the following: <br />WOS— BLANKET — CALIFORNIA <br />WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY <br />WC 04 03 06 (ED. 4 84) <br />WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT — CALIFORNIA <br />WE HAVE THE RIGHT TO RECOVER OUR PAYMENTS FROM ANYONE LIABLE FOR AN <br />INJURY COVERED BY THIS POLICY. WE WILL NOT ENFORCE OUR RIGHT AGAINST <br />THE PERSON OR ORGANIZATION NAMED IN THE SCHEDULE. (THIS AGREEMENT <br />APPLIES ONLY TO THE EXTENT THAT YOU PERFORM WORK UNDER A WRITTEN <br />CONTRACT THAT REQUIRES YOU TO OBTAIN THIS AGREEMENT FROM US.) <br />YOU MUST MAINTAIN PAYROLL RECORDS ACCURATELY SEGREGATING THE <br />REMUNERATION OF YOUR EMPLOYEES WHILE ENGAGED IN THE WORK DESCRIBED IN <br />THE SCHEDULE. <br />THE ADDITIONAL PREMIUM FOR THIS ENDORSEMENT SHALL BE 0% OF THE <br />CALIFORNIA WORKERS' COMPENSATION PREMIUM OTHERWISE DUE ON SUCH <br />REMUNERATION. <br />SCHEDULE <br />PERSON OR ORGANIZATION JOB DESCRIPTION <br />WHEI,REQUkI,RED BY A WRITTEN CONTRACT INSURANCE INSPECTIONS <br />POLICY NUMBER WC 5896463 -03 WITHIN THE STATE OF CALIFORNIA <br />U -WC -178 -C (8193) <br />