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5 <br /> WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 <br /> WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - <br /> CALIFORNIA <br /> We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not <br /> enforce our right against the person or organization named in the Schedule. (This agreement applies only to the <br /> extent that 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 <br /> the work described in the Schedule. <br /> The additional premium for this endorsement shall be 2%of the California workers' compensation premium <br /> otherwise due on such remuneration. <br /> SCHEDULE <br /> PERSON OR ORGANIZATION JOB DESCRIPTION <br /> ANY PERSON OR ORGANIZATION FOR WHOM YOU ARE BLANKET WAIVER OF SUBROGATION <br /> REQUIRED BY WRITTEN CONTRACT OR AGREEMENT <br /> TO OBTAIN THIS WAIVER OF RIGHT FROM US PRIOR <br /> TO INJURY. <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: 02/12/2025 Policy No. 7600026637251 Endorsement No. 001 <br /> Insured: M. Brey Electric,Inc. <br /> Premium$ INCL. <br /> Insurance Company: Everest Premier Insurance Company <br /> Countersigned By: <br /> -1998 by the Workers'Compensation Insurance Rating Bureau of California.All rights reserved. <br /> From the WCIRB's California Workers'Compensation Insurance Forms Manual-1999. <br />