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W C 04 03 06 <br />JRKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY (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 Soliicry. toethe oil riotentforc you <br />our <br />right against the person or organization named in the Schedule. (This agreement app y <br />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 work <br />described in the Schedule. <br />The additional premium for this endorsement shall be =o/a of the California workers' compensation premium otherwise <br />due on such remuneration. <br />Ll <br />Schedule <br />Penson or Organization <br />Job Description <br />WHERE YOU ARE REQUIRED BY WRITTEN CONTRACT TO <br />OBTAIN THIS AGREEMENT FROM US, PROVIDED THE <br />CONTRACT IS SIGNED AND DATED PRIOR TO THE DATE OF <br />LOSS TO WHICH THIS WAIVER APPLIES, IN NO INSTANCE <br />SHALL THE PROVISIONS AFFORDED BY THIS <br />ENDORSEMENT BENEFIT ANY COMPANY OPERATING <br />AIRCRAFT FOR HIRE. <br />"The premium charge for this endorsement shall be 2% of the premium developed in the State of California. but not less <br />than $500 policy minimum premium. <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 613012006 Policy No. bb'Iuouoaa <br />Insured rtN THOMPSON, INC. <br />Insurance Company SEA BRIGHT INSURANCE COMPANY <br />Countersigned By <br />•WC 04 03 06 <br />(Ed. 4.84) <br />91998 by the worker' Compensation Insurance Rating aumau of California- All dBlrta reserved. <br />Endorsement No. <br />Policy Effective Date 6/3012006 <br />