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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 <br />(Ed. 4-84) <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 2_5% of the California workers' compensation premium <br />otherwise due on such remuneration. <br />Schedule <br />Person or Organization Job Description <br />Blanket Waiver of Subrogation As respects to all CA jobs performed by the named <br />insured during the policy period where by written contract <br />a waiver of subrogation is required prior to the <br />commencement of work. <br />This endorsement changes the pollcy 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 07-01-2025 Policy No. EAW00003306-00 Endorsement No. <br />Insured U & I General Contract, Inc. (a Corp) Insurance Company Endurance Assurance Corporation <br />Countersigned By <br />01998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved. <br />