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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY <br /> CopN Poirrt. <br /> Insurance Companies <br /> COPPERPOINT • ALASKA NATIONAL <br /> CALIFORNIA 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 you <br /> perform work under a written contract that requires you to obtain this agreement from us). <br /> Schedule <br /> Anyone for whom you have agreed to provide this Waiver subject to the terms of the endorsement <br /> This endorsement changes the policy to which it is attached and, unless otherwise stated, is effective on the date issued <br /> at 12:01 A.M. standard time at your mailing address shown in the policy. The information below is required only when <br /> this endorsement is issued subsequent to commencement of the policy. <br /> Endorsement Effective 12/01/2024 Policy No. WC1025483 Endorsement No. <br /> Insured CWE Premium $ 566.00 <br /> Insurance Company Pacific Compensation Insurance Company Countersigned by <br /> Authorized Representative <br /> WC 99 03 15 A <br /> (Ed. 05-2023) <br /> Contains Copyrighted material of WCIRB,used with permission <br />