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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 03 13 C <br /> (Ed. 7-09) <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 <br /> not enforce our right against the person or organization named in the Schedule. {This agreement applies <br /> only to the extent that you perform work under a written contract that requires you to obtain this <br /> agreement from us.) <br /> You must maintain payroll records accurately segregating the remuneration of your employees while <br /> engaged in the work described in the Schedule. <br /> The additional premium for this endorsement shall be $ 500 <br /> Schedule <br /> Any person or organization that you perform work for that is liable for an injury, covered by this policy, that <br /> prior to the injury has written contract requiring a waiver of our right to recover from them, <br /> Person or Organization Job Description <br /> This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. <br /> 1The Information below Is required only when this endorsement is issued subsequent to preparation of the policy.) <br /> Endorsement Effective 6/5/2026 Poiicy No.CW WCP-1-00-146.747 Endorsement No. 000 <br /> Insured Orange County Children's Therapeutic Arts <br /> Insurance Company Accident Fund Ins.Co. Countersigned by <br /> WC990313C <br /> jEd. 7-09) <br />