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I WORKERS COMPENSATION <br />TRAVELERS <br />AND <br />EMPLOYERS LIABILITY POLICY <br />ENDORSEMENT WC 99 03 76 ( A) — <br />POLICY NUMBER: UB-lY475765-24-26-G <br />WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS <br />ENDORSEMENT - CALIFORNIA <br />(BLANKET WAIVER) <br />We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not <br />enforce our right against the person or organization named in the Schedule. <br />The additional premium for this endorsement shall be 02.000 % of the California workers' compensation pre- <br />mium. <br />Schedule <br />Person or Organization Job Description <br />ANY PERSON OR ORGANISATION rOR <br />WHICH THE INSORW HAS AGREED <br />BY WRITTEN CONTRACT EXECUTED <br />PRIOR TO LOSS TO EVRNISH THIS <br />WAIVER. <br />This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise <br />stated. <br />(The information below is required only when this endorsement is issued subsequent to preparation of <br />the policy.) <br />Endorsement Effective 05/01/2024 Policy No. UB-lY475765-24-26-G <br />Insured Paulus Engineering, Inc. <br />Insurance Company Countersigned by <br />Travelers Property Casualty Company of America <br />Endorsement No. <br />Premium <br />DATE OF ISSUE: 05/01/2024 ST ASSIGN: Page 1 of 1 <br />