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WORKERS.COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 <br /> (Ed. 04784) <br /> WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT—CALIFORNIA <br /> Vye have the right td recover our payments from anyone liable for.an injury 6 ered by this policy: We Will hot ehforco our <br /> right against the person or organlzatiQh ha'rnod in the Schedule. (This agreement applies only to the eXterit that you <br /> perfori'n work under a Written;contract that requires you to obtain this agreometi figrri US:} <br /> You must maintain payroll records accurately aegregatincg the remuneration of your employees while:engaged in the work <br /> described in the Schedule. <br /> The additional prerh!Wm for this:oridbrsernent shall be._ "` % of the Califcirnia workers'compensation prerniuM othetwise <br /> d ae on such remunoratior. <br /> Schedule <br /> Person of Organiizatnoin Job Description <br /> WHERE YOU ARE REQUIRED BY WRITTEN CONTRACT TO <br /> jOBTAtiv THIS AGREEMENT FROM US; PROVIDED THE <br /> CONTRACT 1S 51GNEQ AND DATE© PRIOR Tq THE DATE OF <br /> LOSS TO WHICH THIS WAIVER APPLIES. IN NO INSTANCE <br /> sHALL THE PROVISIONS AFFORDED BY THIS <br /> ENDORSEMENT BENEFIT ANY COMPANY OPERATING <br /> AIRCRAFT FOR KI RE. <br /> *The premium charge for this endorsement shall be 2% of the premium developed in the State of California; but not less <br /> than$500 policy minimum premium. <br /> This.endorsernerit ehang6s;the policy tp 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:ta preparation of the policy.) <br /> Endorsement Effective 03-01.20.25 policy,No. T10251022 Endorsement No. <br /> Insured Berg&-Associates Inc Policy-Effective Date 08.01-2025 <br /> Insurance Company StarStone-Naional Insurance Company <br /> Counte.rsigned:.By <br /> WC 04 03 06 <br /> (Ed. 04-84) <br /> 01.998 by the Rating Bu"rmau of California:,fit rfoits resarwed, <br />