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WORKERS' COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 <br />(Ed. 4-84) <br />Issued to PACIFIC ADVANCED CIVIL ENGINEERING, INC DBA: PACE <br />By AMERICAN HOME ASSURANCE COMPANY <br />Policy # WC 3426866 <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 <br />policy. We will not enforce our right against the person or organization named in the Schedule. <br />(This agreement applies only to the extent that you perform work under a written contract that <br />requires you to obtain this agreement from us.) <br />You must maintain payroll records accurately segregating the remuneration of your employees <br />while engaged in the work described in the Schedule. <br />The additional premium for this endorsement shall be 5% of the California workers' <br />compensation premium otherwise due to such remuneration. <br />SCHEDULE <br />Name of Person or Organization: Blanket as required by written contract. <br />