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110110111110—:11 <br />POLICY DATES: 12/18/2019 TO <br />12/18/20O <br />WORKERS COMPENSATION <br />AND <br />EMPLOYERS LIABILITY POLICI <br />ENDORSEMENT — CALIFORNIA <br />(BLANKET WAIVER) <br />We have the right to recover our payments from anyone liable for an, injury covered by this <br />policy. We will not enforce our right against the person or organization named in the Schedule. <br />You must maintain payroll records accurately segregating the remuneration of your employees <br />while engaged in the work described in the Schedule. <br />The additional premium for this endorsement shall be 3 % of the California workers' <br />compensation premium otherwise due on such remuneration, <br />W3EM3MZNrME= <br />ZrAJ :J I I a' 0102KO]r <br />I E-91 I nE USTM77777= <br />THE LOSS. <br />& Nppj�OVED <br />NAC �mFmy D`ivisiOm <br />By Risl(MA I- <br />