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Policy Number: 72 WEAB2915 Endorsement Number: <br />Effective Date: 08/01/24 Effective hour imthe same aastated onthe Information Page ofthe policy. <br />Named Insured and Address: BUFlKE.VV|LL|AK8S & SORENSENLLP <br />444SFLOWER STSTE24OO <br />LOBANGELESCAD8O71 <br />We have the right to recover our payments from anyone liable for an injury covered by this policy.VVewill not enforce our <br />right against the person or organization named in the Schedule. (Thin agreement applies only to the extent that you <br />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 ofyour employees while engaged inthe work <br />described in the Schedule. <br />The additional premium for this endorsement shall be296ofthe California workers' compensation premium otherwise due <br />onsuch remuneration. <br />Job Description <br />Any person or organization for whom you are required by written contract or agreement to obtain this waiver of rightsfrom <br />us <br />Countersigned by <br />Authorized Representative <br />Form WC 0403 06 (1)Printed inU.S.A. <br />Process Date: O7/ 0/24 Policy Expiration Date: OD/O1/25 <br />