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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 34 <br /> (Ed. 8-00) <br /> WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-BLANKET <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 /> The additional premium for this endorsement shall be % of the total California Workers' Compensation premium <br /> otherwise due. <br /> Schedule <br /> Person or Organization Job Description <br /> ANY PERSON OR <br /> ORGANIZATION FOR <br /> WHOM THE NAMED <br /> INSURED IS REQUIRED <br /> UNDER THE WRITTEN <br /> CONTRACT TO FURNISH <br /> THIS 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 06/09/2025 Policy No. WSA 5084780 00 Endorsement No. <br /> Insured INTER-PACIFIC INC Premium <br /> Insurance Company INSURANCE COMPANY OF THE WEST <br /> Countersigned By <br /> WC 99 06 34 <br /> (Ed. 8-00) <br /> INSURED <br />