Laserfiche WebLink
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY <br />WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA <br />WC 04 03 06 <br />(Ed. 04-84) <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 <br />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 the <br />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 />Where required by contract <br />Any person or organization to whom you become obligated to waive <br />your rights of recovery against, under any contract or agreement you <br />enter into prior to the occurrence of loss. <br />This endorsement changes the policy to which it is attached and Is effective on the date Issued unless otherwise stated. (The <br />information below is required only when this endorsement Is Issued subsequent to preparation of the policy.) <br />Endorsement Effective: ❑®0®m4 <br />Insured: Integrated Demolition & Remediation, Inc. <br />Insurance Company: Starr Indemnity & Liability Company <br />Policy No.: 100 0004638 Endorsement No.: <br />Premium: <br />Countersigned by: <br />WC 04 03 06 <br />(Ed. 04-84) Page 1 of 1 <br />