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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY <br />Padf iccomp• WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - <br />A CopperPoint Insurance Company BLANKET <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 <br />you perform work under a written contract that requires you to obtain this agreement from us). <br />The additional premium for this endorsement shall be <br />otherwise due (minimum $100). <br />Person or Organization <br />Any person or organization for whom <br />the named insured is required under <br />written contract to furnish this waiver <br />2.00 % of the California workers' compensation premium <br />Schedule <br />Job Description <br />RE: All California Operations <br />This endorsement changes the policy to which it is attached and is effective on the policy effective date unless otherwise stated. <br />This endorsement, effective on 06-01-20 <br />Policy Number wA-005984-01 of the <br />Policy Effective Date 06-01-20 to 06-01-21 <br />Insured Name IEC corporation <br />Premium $ <br />Countersigned at Thousand Oaks CA on <br />1000-10-0192J <br />WC 99 03 15 (Ed 10-07) <br />at 12:01 A.M. standard time, forms a part of <br />Pacific Compensation Insurance Company <br />NCCI Carrier Code 11555 <br />Endorsement No. <br />ISSUED 06/01/20 AT 07:40 AM BY SER <br />Authorize <br />�ry.rype RlekMmagemaitDNls[on. <br />yf% REVIEWED&APPROVED By:. <br />Ii IiiilcM�n2gamertt MalysY <br />