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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 03 13 C <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 $ <br /> Schedule <br /> Any person or organization that you perform work for that is liable for an injury, covered by this policy, that <br /> prior to the injury has written contract requiring a waiver of our right to recover from them. <br /> Person or Organization Job Description <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 10/24/2025 Policy No. CWWCP100134834 Endorsement No. <br /> Insured R P W Services, Inc. 41 y1 <br /> Insurance Company CompWest Countersigned by <br /> WC990313C <br /> (Ed. 7-09) <br />