Laserfiche WebLink
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 <br /> (Ed.04-84) <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 our right <br /> against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work <br /> 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 due on <br /> such remuneration. <br /> Schedule <br /> Person or Organization Job Description <br /> Where required by written agreement signed prior to loss All California Operations. <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 12/31/2025 Policy No.WEC300169203 Endorsement No. <br /> Insured Insurance Company XL Specialty Insurance Company <br /> United Storm Water,Inc. <br /> Countersigned By <br /> WC 04 03 06 Page 1 of 1 <br /> (Ed. 04-84) Copyright 1984 Workers'Compensation insurance Rating Bureau of California.All Rights Reserved. <br />