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WOR}�RS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC Od 03 OS <br />CA10000979091 6/29/2009 <br />TSCM Corp <br />WAIVER OF OUR R[GHT TO RECOVER FROM OTHERS ENDORSEMENT - <br />CALI FORN IA <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 2 % of the California workers' compensation premium <br />otherwise due on such remuneration. <br />SCHEDULE <br />PERSON OR ORGANIZATION <br />t� L �7 7 Tom' I �T 7 F i i C �3 <br />ANY PERSON OR ORGANS ZATION FOR WF-IOM ALL OPERATIONS <br />THE NAMED 2NSURED HAS AGREED BY <br />WR2TTEN CONTRACT TO FURNSSH THSS <br />WAS VER - <br />- 1998 by the Workers' Comper ®lion Insurance Rating Bureau of Calitornta. All rigkts r¢se rved. <br />From the WCIRB's California Workers' Compensation Insurance Forrrts Manua[ - 1999, <br />cexr ao.: sza�oas cr.xe�ur cone: cinnsa cinnic ciarka s /zs /zoos z:oa:sa en RL�Sur'e�}y io <br />