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WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY <br />r e � r � m. ■mu <br />WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT- <br />CALIFORNIA <br />This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a <br />different date is indicated below. <br />[The following [attaching clausemieed be completed only when this endorsement is issued subsequent to preparation of the policy.[] <br />This endorsement, effective on 10101/2024 at 12:01 A.M. standard time, forms a part of <br />UDAT❑❑ <br />Policy ❑o. WC 5646573 - 01 <br />of the <br />issued to Lead Electric, Inc. <br />Premium df any❑D <br />❑ndorsement ❑o. <br />Zurich American Insurance Company <br />IIDAM❑ OF IDSORA❑C❑ COMPADY❑ <br />Authorized Representative <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. [This agreement applies only to the <br />eC2ent that you perform wor❑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 <br />the wor❑described in the Schedule. <br />The additional premium for this endorsement shall be <br />mium otherwise due on such remuneration. <br />Schedule <br />Person or Organization <br />ALL PORSO❑S A❑DiOR <br />ORGA❑IZATIOOS THAT ARE] <br />R❑Q❑IRDD BY WRITT❑❑ CO❑TRACT <br />OR AGR❑❑M❑❑T WITH THE] [E]SORDID, <br />❑D❑COTDD PRIOR TO THE] ACCID❑OT <br />OR LOSS, THAT WAIV❑R OF <br />S❑BROGATIO❑ B❑ PROVIDDD ❑❑D❑R <br />THIS POLICY FOR WORE P❑RFORM❑D <br />BY YO❑ FOR THAT P❑RSO❑ A❑DEDR <br />ORGA❑ IZATIO ❑ <br />WC 2E2 ®®m <br />WC 0003 OD ®d. DUQI1 <br />❑ of the California woroars❑compensation pre❑ <br />Job Description <br />ALL CA OP❑RATIO❑S <br />Page 1 of 1 <br />