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Policy Number: 10WEAU9T8V <br /> Policy Term: 11/1/2024 - 11/1/2025 <br /> THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br /> WAIVER OF OUR RIGHT TO RECOVER FROM <br /> OTHERS ENDORSEMENT - 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 % of the California workers' compensation premium <br /> otherwise due on such remuneration. <br /> SCHEDULE <br /> Person or Organization Job Description <br /> As required by written contract Project notated in contract <br /> APPROVED <br /> By Cynthia Mora at 2:03 pm, Dec 03, 2024 <br /> Countersigned by <br /> Authorized Representative <br /> Policy No. 10 WEA AU9T8V <br /> Form WC 04 03 06 (1) Printed in U.S.A. <br /> Process Date: Policy Expiration Date: <br />