Laserfiche WebLink
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY We 9904 1 O (Ed 07-07) <br />WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT -CALIFORNIA <br />BLANKET BASIS <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 />The additional premium for this endorsement shall be 0.00 % of the total policy premium otherwise due on <br />such remuneration. <br />The minimum premium for this endorsement is $ 0.00 <br />Schedule <br />Person or Organization Job Description <br />THE WAIVER OF SUBROGATION IS ISSUED FOR ALL CALIFORNIA OPERATIONS <br />REDWOOD CITY, THE CITY, ITS COUNCIL, OFFICERS, <br />OFFICIALS, AGENTS, EMPLOYEES AND VOLUNTEERS <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: 10/23/2025 Policy No. 9289015-24 Endorsement No. 1 <br />Insured: LUMAT INC dba Limon Mountain View, Inc. Premium:$0.00 <br />Insurance Company: Countersigned by ------- — — ----- <br />p Y� <br />State Compensation Insurance Fund <br />We 99041 OA <br />(Ed 07-07) <br />ATTY/AGR.2025.337/Limon (885 Middlefield Rd) (Page 22 of 32) <br />