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_WORKERS COMPENSATION AND MP OY RS I BI ITY INSURANCE POLICY WC an n4 10 C <br /> (Ed.01.19) <br /> WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA <br /> BLANKET BASIS <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 /> The additional premium for this endorsement shall be calculated by applying a factor of 2%to the total manual <br /> premium, with a minimum initial rharne of$aso, then applying all other pricing factors for the policy to this ac lcu atPd <br /> charge to derive the final cost of this endorsement. <br /> This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. <br /> ftbadkin <br /> Blanket-Waiver <br /> Person/Organization Blanket Waiver—Any person or organization for whom the Named Insured has <br /> wed by written contract to furnish this waiver. <br /> Job Description Waiver Premium(priortoadjustments) <br /> All CA Operations $4,209 <br /> This endorsement changes the DOI! 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: 3/15/2025 PolicyNn.: FOWC623693 EndorsemsnLNo.: <br /> Insured: Premium <br /> Insurance Company: Berkshire Hathaway Homestate Ins Co <br /> Countersigned by <br /> WC990410C <br /> _(Ed.01-19) <br />