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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 not enforce our <br /> right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform <br /> 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 work <br /> described in the Schedule. <br /> The additional premium for this endorsement shall be 2 % of the California workers'compensation premium otherwise <br /> due on such remuneration. <br /> Schedule <br /> Person or Organization Job Description <br /> APPLIES AS BLANKET WAIVER <br /> FOR THOSE HAVING A WRITTEN <br /> CONTRACT WITH THE POLICY- <br /> HOLDER REQUIRING WOS FOR <br /> WC POLICYHOLDER EMPLOYEES . <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 Policy No. WD3-J562882-05 Endorsement No. <br /> Insured <br /> Insurance Company MASSACHUSETTS BAY INSURANCE COMPANY <br /> Countersigned By <br /> WC 04 03 06 (Ed 04-84) <br /> 1,424 <br />