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Johnson-Frank & Associates, Inc. <br />TRAVELERS <br />12/1/2008 <br />WORKERS COMPENSATION <br />AND <br />EMPLOYERS LIABILITY POLICY <br />ENDORSEMENT WC 99 03 76 (00) <br />POLICY NUMBER: <br />WAIVER OF RIGHT TO RECOVER FROM OTHERS <br />ENDORSEMENT -CALIFORNIA <br />(BLANKET WAIVER) <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 />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 3% of the California workers' <br />compensation premium otherwise due on such remuneration. <br />SCHEDULE <br />PERSON OR ORGANIZATION <br />ALL PERSONS OR ORGANIZATIONS <br />THAT ARE PARTIES TO A CONTRACT <br />THAT REQUIRES YOU TO OBTAIN <br />THIS AGREEMENT PROVIDED YOU <br />EXECUTED THE CONTRACT BEFORE <br />THE LOSS. <br />JOB DESCRIPTION <br />~Og~ <br />O <br />DATE OF ISSUE: <br />A~ ~ <br />O~ <br />~~,o <br />v ~,~SP ~~G~~y P <br />Pss~star <br />5 <br />CHRT NO.: 4125447 Hetty Tran 12/1/2008 10:90:98 AM Page 5 <br />