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11111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111 <br />WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA <br />We have the right to recover our payments from anyone liable ot enforce ourfor an injury covered by this policy. We will n <br />ent that you performright against the person or organization named in the Schedule. (This agreement applies only to the ext <br />work under a written contract that requires you to obtain this agreement from us.) <br />dintheworkYou must maintain payroll records accurately segregating the remuneration of your employees while engage <br />described in the Schedule. <br />2KKKKKThe additional premium for this endorsement shall be % of the California workers’ compensation premium otherwise <br />due on such remuneration. <br />Schedule <br />Person or Organization <br />APPLIES AS BLANKET WAIVER <br />FOR THOSE HAVING A WRITTEN <br />CONTRACT WITH THE POLICY- <br />HOLDER REQUIRING WOS FOR <br />WC POLICYHOLDER EMPLOYEES. <br />Job Description <br />n the date issued unless otherwise stated.This endorsement changes the policy to which it is attached and is effective o <br />nt to preparation of the policy.)(The information below is required only when this endorsement is issued subseque <br />Endorsement Effective Policy No. Endorsement No.W23-A427457-12 <br />Insured <br />Insurance Company ALLMERICA FINANCIAL BENEFIT INSURANCE <br />Countersigned By <br />WC 04 03 06 (Ed 04-84) <br />Docusign Envelope ID: DF0F3531-C78A-8495-81AB-E9DA9043C7B4