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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99:04 02 C <br /> (Ed. 9.14) <br /> WAIVED 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 <br /> enforce;our right agoinst.the person or orgarilzatipn turned In the Schedule. (This agreement applies only to the <br /> extent that you perform worst under a written cor.4ract.that requires you to obtain this agreement from us.) <br /> You must:maintain payroll records accurately sggregating the remuneration of your employees while engager in <br /> the work described In the Schedule. <br /> The additional premium for this endorsement shall be 5% of the,sppI c ble manual promlun7 otherwise due on <br /> such remuneration subject to a policy maximum charge for all such waivers of 5% of total manual premium. <br /> The MInimurn premium for this endorsement Is $350.. <br /> This agreement shall not operate directly or Indirectly to be'no. anyone n.at named In the Schedule: <br /> Schedule <br /> Person/ rganizatloh: City of Santa Arta, Its City.Council, officers, officials, empfoyoes, agents And vaiurneors <br /> Job Description: r renatal/Pre.gnancy/Post Natal Education and Support for the City <br /> Waiver Premium. 0,00 <br /> Payroll Subject <br /> Class State to Wainer <br /> 8868 CA 1..00 <br /> This endorsement changes the policy to which It.Is attached.and is effective on the.date Issued unless:otherwise stated. <br /> (The information below is required only when this enrlorsemient is issued subsequent to preparation of the policy.) <br /> Endorsement Effective: 10/01/2024 Policy No..MOWC547866 Endorsement No.; <br /> Insured; Premium$ <br /> Insurance Company:Oak River Insurance Company <br /> Q.ourrtersigned by <br /> WC 99 04 02.C <br /> (Ed, 9-;14) <br />