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WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT <br />This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different <br />date is indicated below. <br />(The following "attaching clause" needs to be completed only when this endorsement is issued subsequent to preparation of the policy.) <br />This endorsement forms apart of Policy No. WZP80954268 <br />Issuedto: LSA Associates, Inc. <br />By: American Automobile Ins. Co. <br />Premium (if any) TBD <br />We have a 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 2-5% of the California workers compensation premium otherwise <br />due on such remuneration. <br />Person or Organization <br />City of Colton <br />Attn: Kimberlyn Richardson <br />650 No. La Cadena Drive <br />Colton, CA 92324 <br />WC 04 03 06 <br />(Ed. 4-84) <br />Schedule <br />The City of Colton <br />Countersigned by <br />W <br />Job Description <br />Authorized Representative <br />