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W1194��� 7 mm <br />OTHERS rr'CALIFORNIA <br />Policy Number: 72 WEC R06780 Endorsement Number: <br />Effective Data: 09/11/17 Effective hour is the same as stated on the Information Page of the policy. <br />Named Insured and Address: AESCO INC. <br />17782 GEORGETOWN LN <br />HUNTINGTON BEAC, CA 92697 <br />We have the right to recover our payments from anyone liable for an injury covered by this policy, We will not <br />enforce our right against the person or organization named in the Schedule, (This agreement applies only to the <br />extent that you 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 <br />the work described in the Schedule. <br />The additional premium for this endorsement shall be <br />premium otherwise due on such remuneration. <br />Person or Organization <br />ANY PERSON OR ORGANIZATION <br />FROM WHOM YOU ARE REQUIRED <br />BY WRITTEN CONTRACT OR <br />AGREEMENT TO OBTAIN THIS <br />WAIVER OF RIGHTS FROM US, <br />CITY OF ARCADIA,, ITS OFFICIALS <br />OFFICERS AND EMPLOYEES <br />290 W HUNTINGTON DR <br />ARCADIA, CA 91007 <br />5 % of the California workers' compensation <br />AS REQUIRED BY WRITTEN <br />CONTRACT, <br />SOIL TESTING <br />n t <br />Countersigned by _ <br />J ; Authorized Representative <br />Form WC OA 03 06 (1) Printed in U.S.A. <br />Process Date: 02/18/17 <br />REVIEWED 6Y: <br />Policy Expiration Date: 04/11/18 <br />