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TRAVELERS COMPENSATION <br />WORKERS <br />AND <br />EMPLOYERS LIABILITY POLICY <br />ENDORSEMENT WC 99 03 76 (00) — 001 <br />POLICY NUMBER: (ISUB-3022N20-8-09) <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 />You must maintain payroll records accurately segregating the remuneration of your employees while engaged in <br />the work described in the Schedule. <br />The additional premium for this endorsement shall be 3.00 <br />mium otherwise due on such remuneration. <br />Schedule <br />Person or Organization <br />ALL PERSONS OR ORGANIZATIONS <br />THAT ARE PARTIES TO A CCNTRACT <br />THAT REQUIRES YOU TO OBTAIN <br />THIS AGREEMENT, PROVIDED YOU <br />EXECUTED THE CONTRACT BEFORE <br />THE LOSS. <br />DATE OF ISSUE: 04-10-09 ST ASSIGN: <br />% of the California workers' compensation pre - <br />Job Description <br />"ALL OPERATIONS." <br />"ANY PERSON OR ORGANIZATION FO <br />WHICH THE INSURED HAS CCMPLSTE <br />A WRITTEN AGREEMENT TO PROVIDE <br />THIS WAIVER." <br />