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INSURED <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <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. Endorsement No. <br />Insured Premium $ <br />Insurance Company <br /> Countersigned By <br /> <br />INSURANCE COMPANY OF THE WEST <br /> INCL. <br /> <br />WC 99 06 34 <br />(Ed. 8-00) <br />WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 34 <br /> <br /> (Ed. 8-00) <br /> <br /> <br />WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - BLANKET <br /> <br /> <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 <br />you perform work under a written contract that requires you to obtain this agreement from us). <br /> <br />The additional premium for this endorsement shall be % of the total California Workers’ Compensation premium <br />otherwise due. <br /> <br />Schedule <br /> <br /> <br /> Person or Organization Job Description <br /> <br /> 3 <br />ANY PERSON / ORG ALL CA OPERATIONS <br />WHEN REQUIRED BY <br />WRITTEN CONTRACT <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />01 <br />George Bianchi Construction, Inc. <br />10-4-2023 WPL 5067540 <br />Docusign Envelope ID: 15F8BE68-D125-405B-9ADC-3D65624EB783