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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 <br /> (Ed. 4-84) <br /> WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT—CALIFORNIA <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 /> You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the <br /> work described in the Schedule. <br /> The additional premium for this endorsement shall be 2% of the California workers' compensation premium <br /> otherwise due on such remuneration. <br /> Schedule <br /> Person or Organization Job Description <br /> All persons or organizations that are party to a contract that Jobs performed for any person or organization that you <br /> requires you to obtain this agreement, provided you executed have agreed with in a written contract to provide this <br /> the contract before the loss. agreement. <br /> This endorsement changes the policy 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 09/01/2025 Policy No. PSW0006370 Endorsement No. <br /> Insured Earth Mechanics,Inc Insurance Company <br /> RLI Insurance Company <br /> Countersigned By <br /> ©1998 by the Workers'Compensation Insurance Rating Bureau of California.All rights reserved. <br />