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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY <br />WC 04 03 06 <br />(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 injury covered by this policy. We will not enforce <br />our right against the person or organization named in the Schedule. (This agreement applies only to the 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 remuneration of your employees while engaged in the <br />work described in the Schedule. <br />The additional premium for this endorsement shall be 1.03 _% of the California workers' compensation premium <br />otherwise due on such remuneration. <br />Schedule <br />Person or Organization Job Description <br />Blanket Waiver -Any person or organization for whom the All CA Operations <br />Named Insured has agreed by written contract to furnish this <br />waiver. <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 Policy No. V9WC937770 Endorsement No. <br />Insured Insurance Company <br />Countersigned By <br />©1998 bythe Workers' Compensation Insurance Rating Bureau of California. All rights reserved. <br />