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<br />WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA <br /> <br />This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different <br />date is indicated below. <br /> <br />(The following "attaching claUse~ need be completed only when this endorsement is issued subsequent to preparation oj \he policy) <br /> <br />This endorsement, effective 12:01 AM 10/31/2006 <br /> <br />torms a part of Policy No. WC <br /> <br />720-59-71 <br /> <br />Issued to POWELL INDUSTRIES, INC. <br /> <br />ByNATJONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA. <br /> <br />Premium INCLUDED <br /> <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 you <br />perform work under a written contract that requires you to obtain this agreement from us). <br /> <br />You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work <br />described in the Schedule. <br /> <br />The additional premium for this endorsement shall be 2.0 <br />otherwise due on such remuneration. <br /> <br />% of the California workers' compensation premium <br /> <br />Schedule <br /> <br />Person or Organization <br /> <br />ANY PERSON OR ORGANIZATION TO WHOM YOU BECOME <br />OBLIGATED TO WAIVE YOUR RIGHTS OF RECOVERY AGAINST <br />UNDER ANY CONTRACT OR AGREEMENT YOU ENTER INTD <br />PRIOR TO THE OCCURRENCE OF LOSS. <br /> <br />Job Description <br /> <br />.A.i-'~RO\/ L~) A~, TU i:CJ1{[\.'i <br /> <br />:;tfi!ILCl/r <br /> <br />L.l.;-" .'.' : ~ ~),._'_uy' <br />,:\ J~')L,.Jl l..-:i1..Y :\l~;ifli~! <br /> <br />we 04 03 06 <br />{Ed. 04184) <br /> <br />Countersigned by <br /> <br />JU ~~!I,,-U~ <br /> <br />INSURED'S COpy <br /> <br />Authorized Representative <br />