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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 <br />rFd 4-841 <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 policy. We will not enforce our <br />right against the person or organization named in the Schedule. (This agreement applies only to the extent that you <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 _% of the California workers' compensation premium otherwise <br />due on such remuneration. <br />`r.. <br />Schedule <br />Peron 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 AFF <br />ENDORSEMENT BENEFIT ANY CC <br />AIRCRAFT FOR HIRE. <br />`The premium charge for this endorsement shall be 2% of the prem! <br />than $600 policy minimum premium. <br />This endorsement changes the policy to which it is attached and is effective <br />(The information below is required only when this endorsement <br />Endorsement Effective 6/30/2006 Policy No, BB1050689 <br />Insured KEN THOMPSON. INC. <br />Insurance Company SEA BRIGHT INSURANCE COMPANY <br />Countersig <br />WC 04 03 06 <br />(Ed. 4-84) <br />C,1998 by the warkera' Corrpensatlon insurance Rating Bureau of California. All rightsreserved. <br />ss <br />