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THISENDORSEMENTCHANGESTHEPOLICY.PLEASEREADITCAREFULLY. <br />WAIVEROFOURRIGHTTORECOVERFROM <br />OTHERSENDORSEMENT-CALIFORNIA <br />PolicyNumber:72WECVK8727EndorsementNumber: <br />EffectiveDate:01/01/22EffectivehouristhesameasstatedontheInformationPageofthepolicy. <br />NamedInsuredandAddress:RSG,INC. <br />17872GILLETTEAVESTE350 <br />IRVINECA92614 <br />Wehavetherighttorecoverourpaymentsfromanyoneliableforaninjurycoveredbythispolicy.Wewillnotenforceour <br />rightagainstthepersonororganizationnamedintheSchedule.(Thisagreementappliesonlytotheextentthatyou <br />performworkunderawrittencontractthatrequiresyoutoobtainthisagreementfromus.) <br />Youmustmaintainpayrollrecordsaccuratelysegregatingtheremunerationofyouremployeeswhileengagedinthework <br />describedintheSchedule. <br />Theadditionalpremiumforthisendorsementshallbe2%oftheCaliforniaworkers'compensationpremiumotherwisedue <br />onsuchremuneration. <br />SCHEDULE <br />PersonorOrganizationJobDescription <br />Anypersonororganizationforwhomyouarerequiredbywrittencontractoragreementtoobtainthiswaiverofrightsfrom <br />us <br />Countersignedby <br />AuthorizedRepresentative <br />FormWC040306(1)PrintedinU.S.A. <br /> <br />ProcessDate:11/22/21PolicyExpirationDate:01/01/23 <br /> <br />