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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY <br />WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT--CALIFORNIA <br />WC 04 03 06 <br />(Ed. 4-84) <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 />Person or Organization <br />Schedule <br />Job Description <br />Any person or organization that you are required to waive Jobs performed for any person or organization that you <br />rights of recovery against in a written contract or agreement. have agreed with in a written contract to provide this <br />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 7/1/2024 Policy No.pSW0004954 Endorsement No. <br />Insured AGA Engineers, Inc. Insurance Company <br />RL! Insurance Company <br />Countersigned By <br />Riek Mvwgvncd DMsimt <br />REviEWED & APPRo/m 8Y: <br />`® Management 5 <br />@1998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved. Risk Mina e9 Pedalfst <br />00851764 1 7/24-25 GL/AUTO/EXCESS/WC/PL Blanket Endas I Pauline Bingham 17/8/2024 11:19:04 AM (PDT) I Page 19 of 19 <br />