Laserfiche WebLink
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />WAIVER OF OUR RIGHT TO RECOVER FROM <br />OTHERS ENDORSEMENT - CALIFORNIA <br />Policy Number:Endorsement Number: <br />Effective Date:Effective hour is the same as stated on the Declarations of the policy. <br />Named Insured and Address: <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 <br />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 the work <br />described in the Schedule. <br />The additional premium for this endorsement shall be <br />otherwise due on such remuneration. <br />% of the California workers’ compensation premium <br />SCHEDULE <br />Person or Organization Job Description <br />Countersigned by <br />Authorized Representative <br />Form WC 04 03 06 Printed in U.S.A. <br />10 WN S41200 <br />01/01/2026 <br />2.00 <br />BUREAU VERITAS HOLDINGS, INC. <br />16800 GREENSPOINT PARK DR. <br />SUITE 300S <br />HOUSTON, TX 77060 <br />ANY PERSON OR ORGANIZATION FROM WHOM YOU ARE REQUIRED BY WRITTEN CONTRACT OR <br />AGREEMENT TO OBTAIN THIS WAIVER OF RIGHTS FROM US. <br />Docusign Envelope ID: 7CF951A9-F5A4-4F8B-B02B-90C4522C309B