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WORKERS• ON AND EMPLOYERSABILITY INSURANCE POLICY WC 990. 10B <br />•i a ,� � e.....'• le" ♦., c <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 you <br />perform work under a written contract that requires you to obtain this agreement from us.) <br />The additional premium for this endorsement shall be 2% of the total manual premium otherwise due on such <br />remuneration. The minimum premium for this endorsement is $350. <br />This agreement shall not operate directly or Indirectly to benefit anyone not named In the Schedule. <br />SCHEDULE <br />BLANKET WAIVER <br />Person/Organization Blanket Waiver— Any person or organization for whom the Named Insured has <br />agreed by written contract to furnish this waiver. <br />Job Description <br />All CA 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 onlywhen this endorsement is Issued subsequent to preparation of the policy.) <br />Endorsement Effective 09/01/2016 Policyl HOWC705376 Endorsement No. <br />Insured <br />Insurance Company Cypress insurance Company <br />Countersigned by <br />WC 99 04103 <br />(Ed.9-14) <br />Premium $ <br />