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�"R�VELiERSAN& WORKERS COMPENSATION <br /> 1/G G AND <br /> EMPLOYERS LIABILITY POLICY <br /> ENDORSEMENT WC 99 03 76( A)— <br /> POLICY NUMBER: UBA8559424 <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 policy. We will not <br /> enforce our right against the person or organization named in the Schedule. <br /> The additional premium for this endorsement shall be % of the California workers' compensation pre- <br /> mium. <br /> Schedule <br /> Person or Organization .lob Description <br /> This endorsement changes the policy to which it Is attached and is effective on the date issued unless otherwise <br /> stated. <br /> (The Information below is required only when this endorsement is Issued subsequent to preparation of <br /> the policy.) <br /> Endorsement Effective 3/1/2025 POLICY No- UBA8559424 Endorsement No. <br /> Insured Pacific Plumbing Company of Santa Ana Premium <br /> Insurance Company Countersigned by <br /> Travelers Property Casualty Co of Amer A++XV <br /> DATE OF ISSUE:3/10/2025 Page 1 of t <br /> 84296662 1 25/26 GL/All/UMB/WC/BOLL I Annette Romero 1 3/10/2025 12:42:07 PM (POT) I Page 12 of 12 <br />