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THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. <br />WAIVER OF OURRIGHT TO RECOVER FROM <br />OTHERS ENDORSEMENT - CALIFORNIA <br />Policy Number:72WEGAY0KW2 Endorsement Number: <br />Effective Date:07/09/25Effective hour is the same as stated on the Information Page of the policy. <br />Named Insured and Address:EC & AM ASSOCIATES, INC <br />2896 VISTA CT <br />DIAMOND BARCA91765 <br />Wehavetherighttorecoverourpaymentsfromanyoneliableforaninjurycoveredbythispolicy.Wewillnotenforceour <br />rightagainstthepersonororganizationnamedintheSchedule.(Thisagreementappliesonlytotheextentthatyou <br />perform work under a written contract that requires you to obtain this agreement from us.) <br />Youmustmaintainpayrollrecordsaccuratelysegregatingtheremunerationofyouremployeeswhileengagedinthework <br />described in the Schedule. <br />Theadditionalpremiumforthisendorsementshallbe2%oftheCaliforniaworkers'compensationpremiumotherwisedue <br />on such remuneration. <br />SCHEDULE <br />Person or OrganizationJob Description <br />Any person or organization for whom you are required by written contract or agreement to obtain this waiver of rights from <br />us <br />Countersigned by <br />Authorized Representative <br />Form WC 04 03 06(1) Printed in U.S.A. <br />Process Date:05/29/25 Policy Expiration Date:07/09/26 <br />97989853!}!36.37!HM.BM.VM.XD.QM!}!Tifssz!Zpvoh!}!903903136!6;63;68!BN!)QEU*!}!Qbhf!21!pg!22 <br /> <br />