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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY <br />WC 04 03 06 <br />(Ed. 04-84) <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 ri ght <br />against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work <br />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 Schedule. <br />The additional premium for this endorsement shall be INCL % of the California workers' compensation premium otherwise due on <br />such remuneration. <br />Person or Organization <br />ANY PERSON OR ORGANIZATION WHERE <br />WAIVER OF OUR RIGHT TO RECOVER IS <br />PERMITTED BY LAW AND IS REQUIRED <br />BY WRITTEN CONTRACT PROVIDED SUCH <br />CONTRACT WAS EXECUTED PRIOR TO <br />DATE OF LOSS <br />Schedule <br />Job Description <br />ALL JOBS UNDER 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 Policy No. <br />Insured New Image Lan Endorsement No. <br />9 MApany Inc Insurance Co*"IA SURANCE COMPANY Premium $ INCL <br />Countersigned By <br />