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Attachment Code: D658506 Certificate 1D: 20958134 <br />WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE COMPANY <br />WC9903013 <br />(Ed. 7-09) <br />WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA <br />We have the right to recover our payments from anyone liable for an injury covered by this policy. We will <br />not enforce our right against the person or organization named in the Schedule. (This agreement applies <br />only to the extent that you perform work under a written contract that requires you to obtain this <br />agreement from us.) <br />You must maintain payroll records accurately segregating the remuneration of your employees while <br />engaged in the work described in the Schedule. <br />The additional premium for this endorsement shall be $ 500 <br />Schedule <br />Person or Organization: <br />All persons or organizations as required by written contract executed prior to the date of loss. This only <br />applies to contracts for work in CA. <br />Job Description: <br />This endorsement changes the policy to which it is attached and is effective on the date issued unless <br />otherwise stated. <br />(The information below is required only when this endorsement is issued subsequent to preparation of the <br />policy.) <br />Endorsement Effective: WC092-00002-24 <br />Policy No.: WC092-00002-24 <br />Endorsement No.: <br />Insured: CATHYJON ENTERPRISES INC. <br />Insurance Company: SUNZ Insurance Company <br />WC 99 03 13 <br />(7-09) <br />