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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 <br /> (Ed. 04-84) <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 policy.We will not enforce our right <br /> against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work <br /> 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 2%of the California workers'compensation premium otherwise due on <br /> such remuneration. <br /> Schedule <br /> Person or Organization .fob Description <br /> Blanket Waiver of Subrogation as required by written contract <br /> This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. <br /> (The Information below is required only when this endorsement is issued subsequent to preparation of the policy.) <br /> Endorsement Effective 11/1/2024 Policy No.99 WC-00003344-00 Endorsement No. <br /> Insured Insurance Company Benchmark Insurance Company <br /> CWF Inc <br /> Countersigned By <br /> i <br /> WC 04 03 06 <br /> (Ed. 04-84) <br /> 64930255 CWFINCA-01 1 25-26 Master Certificate 24-25 WC I Sara Powell 1 4/22/2025 11:27:06 AM SPDP) I page 9 of 9 <br />