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TRAVELERS` WORKERS COMPENSATION <br />AND <br />ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY <br />HARTFORD, CT 061E3 <br />ENDORSEMENT WC 99 03 76 ( A) — 001 <br />POLICY NUMBER: U13-7J230124-20-14 <br />WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS <br />ENDORSEMENT - CALIFORNIA <br />(BLANKET WAIVER) <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. <br />The additional premium for this endorsement shall be 2.00 % of the California workers' compensation pre- <br />mium. <br />Schedule <br />Person or Organization Job Description <br />ANY PERSON OR ORGANIZATION <br />FOR WHICH THE INSURED HAS <br />AGREED BY WRITTEN CONTRACT <br />EXECUTED PRIOR TO LOSS TO <br />FURNISH THIS WAIVER. <br />This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise <br />stated. <br />(The information below is required only when this endorsement is issued subsequent to preparation of <br />the policy.) <br />Endorsement Effective 08/01/2020 Policy No. U13-7J230124-20-14 Endorsement No. <br />Insured MULTIW SYSTEMS, INC Premium <br />Insurance Company Countersigned by <br />TRAVELERS PROPERTY CASUALTY OF AMERICA <br />DATE OF ISSUE: 07/25/2020 ST ASSIGN: CA <br />Rime Management UlMsian <br />iN.e (,REMEWED&{{V <br />A�P'I <br />PIRoVVEDBY. <br />flwta . �RNMK <br />�� Risk Management Analyst <br />