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WIN <br />R <br />Policy Number: 7/2 WEC KU6780 Endorsement Number: <br />Effective Date: 0 4 / 11 / 17 Effective hour is the same as stated on the Information Page of the policy. <br />Named Insured and Address: AESCO INC. <br />1.7782 GEORGETOWN LN <br />HUNTINGTON BEAC, CA 926/47 <br />We have the right to recover our payments frorn 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. (This agreement applies only to the <br />extent that you pet -form 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 <br />the work described in the Schedule. <br />The additional premium for this endorsement shall be <br />premium otherwise due on such remuneration. <br />;ZEEMEI�= <br />ANY PERSON OR ORGANIZATION <br />FROM WHOM YOU ARE REQUIRED <br />BY WRITTEN CONTRACT OR <br />AGREEMENT TO OBTAIN THIS <br />WAIVER OF RIGHTS FROM US, <br />CITY OF ARCADIA, ITS OFFICIALS <br />OFFICERS AND EMPLQYE!�'S <br />240 W HUNTINGTON DR <br />ARCADIA, CA 91.007 <br />% of the California workers' compensation <br />12MMES= <br />AS REQUIRED BY WRITTEN <br />CONTRACT. <br />SOIL TESTING <br />Countersigned by <br />Authorized Representative <br />Form WC 04.03 06 (1) Printed in U.S.A. <br />Process Date: 02 / 18 / 17 <br />Policy Expiration Date: 04/11/18 <br />EUNICE HEREDIA (PG50 <br />