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Attachment Code: D574650 Certificate ID: 16765248 <br />Policy Number, WC0146330 <br />WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY <br />WC 04 03 06 <br />SEci. 4-841 <br />WAIVER. OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT— <br />CALIFORNIA <br />We have the right to recover our payments from anyone liable for an injury covered by this policy. We will <br />not enforce our right against the person or organization named in the Schedule. (This agreement applies <br />only to the extent that you perform work under a written contract that requires you to obtain this <br />agreement from us.) <br />You must maintain payroll records accurately segregating the remuneration of your employees while <br />engaged in the work described in the Schedule, <br />The additional premium for this endorsement shall be 0 % of the California workers' compensation pre, <br />mium otherwise due on such remuneration. <br />Person or Organization Schedule <br />Per attached certificate <br />Job Description <br />ALL PERSONS AND/OR ORGANIZATIONS THAT <br />ARE REQUIRED BY WRITTEN CONTRACTOR <br />AGREEMENT WITH THE INSURED, EXECUTED <br />PRIOR TO THE ACCIDENT OR LOSS, THAT <br />WAIVER OF SUBROGATION BE PROVIDED <br />UNDER THIS POLICY FOR. wow(PERFORMED <br />BY YOU FOR THAT PERSON AND/OR ORGANIZATION <br />WC 252 (4841 <br />WC 04 03 06 (Ed. 4-84) <br />We1Mvw9 mentDiuisinn <br />RE\A wm & APPRQVM SY. <br />f44wW Z Wtv,mt <br />MR Risk Manage tMalyst <br />