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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 <br /> (Ed."4) <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 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 1•00_% of the California workers' compensation premium <br /> otherwise due on such remuneration. <br /> Schedule <br /> Person or Organization Job Description <br /> Blanket Waiver-Any person or organization for whom the All CA Operations <br /> Named Insured has agreed by written contract to furnish this <br /> waiver. <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 Polley No. N9WC795808 Endorsement No. <br /> Insured Insurance Company <br /> Countersigned By <br /> 01998 by the Workers'Compensation Insurance Rating Bureau of California.All rights reserved. <br />