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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY <br />WC 04 03 06 <br />(Ed.04-84) <br />WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT—CALIFORNIA <br />We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce <br />our 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 <br />work described in the Schedule. <br />The additional premium for this endorsement shall be 2_00% of the California workers' compensation premium <br />otherwise due on such remuneration. <br />Person or Organization <br />Schedule <br />Job Description <br />Any Person or Organization as Required By Written Contract Any Person or Organization as Required By Written <br />Contract <br />All Operations of the Name Insured <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 2018-02-01 Policy No. Endorsement No. 1 <br />Insured WC201800005078 <br />Interval House <br />Insurance Company Countersigned By <br />New York Marine and General Insurance <br />Company / 28746 <br />WC 04 03 00 <br />(Ed. 04-84) rU� <br />01998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved. 7of 7 <br />���111 917 <br />