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BLANKET WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT <br /> This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different <br /> date is indicated below. <br /> (The following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy). <br /> This endorsement, effective 07/01/2024 12,01 AM forms a part of Policy No. WC 069365914 CA <br /> Issued to ADP TotalSource DE IV, Inc. <br /> 5800 Windward Parkway <br /> Alppharetta, GA 30005 <br /> LlCIF: <br /> Pacific Services Holdco, LLC, <br /> 2840 Lugo St. <br /> Los Angeles, CA 90023 <br /> By AIU Insurance Company <br /> We have a right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce <br /> our right against any person or organization with whom you have a written contract that requires you to obtain this <br /> agreement from us, as regards any work you perform for such person or organization. <br /> The additional premium for this endorsement shall he^% of the total estimated workers compensation premium for <br /> this policy. <br /> ANY PERSON OR ORGANIZATION TO WHOM YOU BECOME OBLIGATED TO WAIVE YOUR RIGHTS OF <br /> RECOVERY AGAINST, UNDER ANY CONTRACT OR AGREEMENT YOU ENTER INTO PRIOR TO THE <br /> OCCURRENCE OF LOSS <br /> WC 04 03 61 Countersigned by <br /> (Ed. 11/90) Authorizefd Representative <br />