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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC D403 06 <br />Parking Concepts, Inc. <br />POLICY NUMBEFt 4066808769 <br />WAIVER OF OUR RIGHTTO RECOVER FROM OTHERS ENDORSEMENT - <br />CALIFORNIA <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 performwork under a written contract that requires you to obtain this agreementfrom 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 />Theadditionai prerrumfor this endorsement shall be INCL % of the California workers' compensation premium <br />otherwise due on such remuneration. <br />SCHEDULE <br />PERSON ORORGANIZATION JOB DESCRIPTION <br />AS REQUIRED PER <br />WRITTEN CONTRACT <br />OVS .0 <br />`tgA �• STOP toroeY <br />Pss�stant <br />CItY <br />DATE OF ISSUE: <br />©1998 by the Wodcets' Compemgdan Insurance Rating Bureau of Califomia. All rights reserved. <br />From the WCIRB's California Workers' Compensation Insurance Forms Manual ®1999. <br />CPU NO.: 14503022 CLIENT CC05: PARNC Isele Carrillo 30/93/2012 3:52:57 PM Page 2 of 8 <br />