Laserfiche WebLink
The <br />F-1angy <br />Insurance Group_ <br />WH3A427457 1001554 <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 <br />right against the person or organization named In the Schedule, (This agreement applies only to the extent that you perform <br />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 work <br />described in the Soho uls. <br />The additional premium for this endorsement shall be g_% of the California workers' compensation premium otherwise <br />due on such remuneration, <br />Schedule <br />Person or Organization Job Description <br />ONLY WHERE REQUIRED BY CONTRACT <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 9/24/17 Policy No. W10 -A427457-04 Endorsement No, <br />Insured NNS GOVERIOGM FINANCE GROUP Premium $ <br />Insurance Com party THE HAN OVER INSURANCE COMPANY <br />Countersigned By, .� lr C N4�r <br />WC 04 03 06 (Ed. 04-84) <br />