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WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - <br />CALIFO <br />We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not <br />enforce our right against the person or organization named in the Schedule. (This agreement applies only to the <br />extent that 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 remuneration of your employees while engaged in <br />the work described in the Schedule. <br />The additional premium for this endorsement shall be % of the California workers' compensation premium <br />otherwise due on such remuneration. <br />Schedule <br />Additional premium is a percent of the California Manual Workers Compensation premium. Subject to a minimum <br />premium charge of $ <br />Person or Organization Job Description <br />ANY PERSON OR ORGANIZATION FOR WHICH THE NAMED iNSURED 11AS <br />AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO THE ACCIDENT <br />OR LOSS TO FURNISH THIS WAIVER. <br />For attachment to Policy No. WC6Z91462'442047 <br />WC 04 03 06 <br />Ed: 04/1984 <br />Effective Date 05/0I/20I r Premium $ <br />Page 1 of 1 <br />�,__..e._..._____ <br />_ � C:i.1d�dICC Fll�f�t:C�IA 6 C 06= _._ <br />