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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY <br />WC 990306 <br />WAIVER OF SUBROGATION <br />We agree that in consideration of the additional premium charged, the Right of Subrogation Clause contained in <br />this policy is hereby waived as respects the following person or entities: <br />"Any person or organization to whom you are obligated by valid written contract wherein you have <br />agreed to furnish this waiver." <br />This endorsement applies only to those persons or entities listed in the foregoing paragraph. <br />You must maintain payroll records accurately segregating the remuneration of your employees while engaged in <br />the work for which this waiver will apply. <br />11 be The additional premium <br />for this <br />nand will endorsement <br />the n be collected oupon completion of he final audit. <br />of the California workers' mpensation premium <br />This endorsement changes the policy to which it is attached effective on the inception date of the policy unless different <br />date is indicated below. <br />Endorsement Effective <br />Rincon Consultants, Inc (A Corp) <br />Named Insured <br />2/1/2008 Policy No. <br />DCP000341-00 <br />Insurance Company <br />Endorsement No. <br />DELOS INSURANCE COMPANY <br />001 <br />Countersigned By <br />