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THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. <br />WAIVER OF OURWAIVER OF OURRIGHT TO RECOVER FROMRIGHT TO RECOVER FROM <br />OTHERS ENDORSEMENT - CALIFORNIAOTHERS ENDORSEMENT - CALIFORNIA <br />Policy Number: <br />Endorsement Number: <br />Effective Date:0 <br />Effective hour is the same as stated on the Information Page of the policy. <br />Named Insured and Address:HUITT ZOLLARS, INC. <br />1717 MCKINNEY AVE STE 1400 <br />DALLASTX75202 <br />Wehavetherighttorecoverourpaymentsfromanyoneliableforaninjurycoveredbythispolicy.Wewillnotenforceour <br />rightagainstthepersonororganizationnamedintheSchedule.(Thisagreementappliesonlytotheextentthatyou <br />perform work under a written contract that requires you to obtain this agreement from us.) <br />Youmustmaintainpayrollrecordsaccuratelysegregatingtheremunerationofyouremployeeswhileengagedinthework <br />described in the Schedule. <br />Theadditionalpremiumforthisendorsementshallbe2%oftheCaliforniaworkers'compensationpremiumotherwisedue <br />on such remuneration. <br />SCHEDULE <br />Person or OrganizationJob Description <br />Any person or organization from whom you are required by written contract or agreement to obtain this waiver of rights <br />from us <br />Countersigned by <br />Authorized Representative <br />1:012033 <br />Policy Expiration Date: <br />Form WC 04 03 06(1)Printed in U.S.A. <br /> <br /> <br />