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WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - <br />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 against the person or organization named In the Schedule. (This agreement applies only to the <br />extent that 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 <br />the work described in the Schedule. <br />The additional premium for this endorsement shall be % of the California workers' compensation premium <br />otherwise due on such remuneration. <br />Schedule <br />Additional premium Is a percent of the California Manual Workers Compensation premium. Subject to a minimum <br />premium charge of $ <br />Person or Organization <br />ANY PERSON OR ORGANIZATION FOR WRICH TILE NAMED INSURED HAS <br />AGREP.D BY WRITTEN CONTRACT EXECUTED PRIOR TO THE ACCIDENT <br />OR LOSS TO FURNISH THIS WAIVER. <br />Issued by <br />For attachment to Policy No. WC5Z9146244204'7 <br />Issued to <br />WC 04 03 06 <br />Ed: 0411984 <br />Job Descrl tion <br />Effective ©ate 05/01/2017 Premium $ <br />Page 1 of 1 <br />