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Insured: RMC Water and Environment <br /> Policy Number: UB3916T448 <br /> Effective Date: 07/01/14 <br /> THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br /> WAIVER OF OUR RIGHT TO RECOVER FROM <br /> 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 <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 Califomia workers' compensation premium <br /> otherwise due on such remuneration. <br /> SCHEDULE <br /> Person or Organization Job Description <br /> SCHEDULE CONTINUATION:City of Pleasanton,its officers,employees and agents. <br /> City of Pleasanton <br /> Attn:Dave Requa <br /> P.O.Box 520 <br /> Pleasanton,CA 94566 <br /> Countersigned by asCiassii 61-17" <br /> Authorized Representative <br /> Form WC 04 03 06 (1) Printed in U.S.A. <br /> Process Date: Policy Expiration Date: <br />