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Hanover <br />lnsuraete Group.. <br />WH3A427457 1001554 <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 byy this policy. We will not enforce our <br />right against the person or organization named In the Schedule, (This agreement app lea only to the extent that you perform <br />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 work <br />described in the Sohsdule. <br />The additional premium for this endorsement shelf b®J_ % of the California workers' compensation premium otherwise <br />due on such remuneration, <br />Schedule <br />Person or Organization Job Description <br />ONLY WHERE REQUIRED BY CONTRACT <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 />EndoreementEffectIve 9/24/17 Policy No. W10 -A427457 -Q4 Endorsement No. <br />Insured NNS GOVERNHIM BINANGE GROUP Premium $ <br />Insurance Company'Ci#t. HANOVck tNSURANCG CCM?ANY <br />CountersignedBy,, 1 f m <br />WC 04 03 06 (Ed. 04-84) <br />