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Named Insured: RJM Design Group, Inc. <br />Policy Number: PSW0004066 <br />WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 <br />(Ed. 4-84) <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 <br />our right against the person or organization named in the Schedule. (This agreement applies only to the extent that <br />you perform work 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 <br />work described in the Schedule. <br />The additional premium for this endorsement shall be % of the California workers' compensation premium <br />otherwise due on such remuneration. <br />Person or Organization <br />All persons or organizations that are party to a <br />contract that requires you to obtain this <br />agreement, provided you executed the contract <br />before the loss. <br />Schedule <br />Job Description <br />Jobs performed for any person or organization that you <br />have agreed with in a written contract to provide this <br />agreement. <br />©1998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved. <br />REVIEWED BY: EUNICE HEREDIA (P OF(J ) <br />v � <br />