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WAFVER OF OUR RIGHT TO AI:COVER I=RQM OTHERS ENDORSEMENT--CALIFORNIA <br />This endorsement changes the policy to which it is attached effective on t118 inception date of the policy unless a different <br />date is indicated below. <br />(The tollowiog "attaching olause" need be completed only when inie elxlorsement i8 issued subsequent to preparation of the polity). <br />This endorsement, effective 12:01 AM ob/2g/2007 <br />lssuedto TYCO INTERNATIONAL MANAGEMENT COMPANY <br />By AMERICAN HOME ASSURANCE COiNPANY <br />Premium INCLUDED <br />forms a part of Policy No. WC i 61-65- 76 <br />We have the right to recover our payments from anyone liable for an injury covered by this policy. YVe will not enforce <br />our r[ght 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 <br />otherwise due on such remuneration. <br />9'0 of the California workers' Compensation prerniurn <br />Schedule <br />Rerson or t]raanization <br />.fob Description <br />ANY PER50N OR ORGANFZATION i'O WHOM YOU $ECOME <br />OBLtGA'TED TO WAIVE YOUR RIGHTS OF RECOVERY <br />AGAINST, UNDER ANY CONTRACT OR AGREEMENT YOU <br />ENTER INTp PR10ft TO THE OCCURRENCE OF LOSS. <br />WC 04 d3 08 Countersigned by ~~~"~''"~ <br />Ill~d. sues) <br />Authorlxed Representative <br />