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TATSUMI & PARTNERS, INC A-2009-022 REVIEWED BY: EUNICE HEREDIA (PG 2 OF 6) <br />TRAVELERS WORKERS COMPENSATION <br />AND <br />EMPLOYERS LIABILITY POLICY <br />ENDORSEMENT WC 99 03 76(00) — 001 <br />POLICY NUMBER: UB7095Y638 <br />WAIVER OF OUR 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 <br />employees while engaged in the work described in the Schedule. <br />The additional premium for this endorsement oh8U be 3.00 96 of the California workers' <br />compensation premium otherwise due on such remuneration. <br />Person cvOrganization <br />ALL PERSONS ORORGANIZATIONS <br />THAT REQUIRES YOU nO OBTAIN <br />EXECUTED THE CONTRACT BEFORE <br />DATE {]FISSUE: s/2o/zozs <br />Schedule <br />Job Description <br />THAT ARE PARTETO A CONTRACT <br />THIS AGREEMENT, PROVIDED YOU <br />THE LOSS. <br />STASSIGN: cu <br />