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WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY <br />WC 99 03 04 (Fd. 7-08) <br />WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - <br />CALIFORNIA <br />This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is <br />indicated below. <br />(The following "atmching louse" need be completed only when dais endonsemeet is i,.ed subsequent to pnspent ion of the policy.) <br />This endorsement, effective on 4/30/2017 at 12:01 A.M. standard tune, forms a part of <br />(DATE) <br />Policy No. 71750505 of the FEDERAL INSURANCE COMPANY <br />(NAME OF INSURANCE COMPANY) <br />issued to BEST BEST & KRIEGER LLP <br />Trulorsement No. <br />We have the fight to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right <br />against the person or organization named in the Schedule. The additional premium for the blanket waiver offered by this endorsement <br />shall be 1.00% of total California premium <br />Schedule <br />Person or Organization <br />BLANKET WAIVER -ANY PERSON OR ORGANIZATION FOR <br />WHOM TIIE NAMED INSURED HAS AGREED BY WRITTEN <br />CONTRACT TO FURNISH THIS WAIVER <br />WC 99 03 04 (FD. 7-08 <br />Attaclnnent Code : D466017 <br />Certificate ID : 11767171 <br />Job Description <br />ALL CALIFORNIA OPERATIONS <br />Page 1 of 1 <br />