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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY �3 0 <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 against the <br /> person or organization named in the Schedule.(This agreement applies only to the extent that you perform work under a written contract <br /> 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 described in the <br /> Schedule. <br /> The additional premium for this endorsement shall be %of the California workers'compensation premium otherwise due on such <br /> remuneration. <br /> Schedule <br /> Person or Organization Jab Description <br /> ANY PERSON(S)OR ORGANIZATION(S)WITH WHOM YOU HAVE AGREED TO SUCH WAIVER,IN A VALID WRITTEN CONTRACT OR WRITTEN <br /> AGREEMENTTHAT HAS BEEN EXECUTED PRIOR TO LOSS. <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:07/01/2025 Policy No.:WCC340082A Endorsement No. <br /> Insured;Ocean Blue Environmental Services,Inc. Insurance Company:National Casualty Company <br /> Countersigned By <br />