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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 <br />Parking Concepts, Inc. <br />POLICY NUMBER 4066808769 <br />WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - <br />CAUFORNIA <br />We have the right to recover our payments from anyone liablefor an injury covered by this policy. Wewill not enforce <br />our right against the person or organization named in the Schedule. (This agreement applies only to the extent that <br />you perform 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 the <br />work described in the Schedule. <br />The additional prerniu m f or this endorsement shall be INCL % of the California workers' compensation premium <br />otherwise due on such remuneration. <br />SCHEDULE <br />PERSON OR ORGANIZATION JOB DESCRIPTION <br />AS REQUIRED PER <br />WRITTEN CONTRACT <br />510 e <br />�\SN C1ty FttOC� y <br />Nss�stav\ <br />DATE OF ISSUE: <br />©1998 by the Workers' Compensation Insurance Rating Bureau of Calffomia. All rights reserved. <br />From the WCIRB's California Workers' Compensation Insurance Farms Manual © 1999. <br />CERT NO.: 14502022 CLIENT CODE: PARKC Isela Carrillo 10/23/2012 3:52:57 PM Page 2 of 8 <br />