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WORKERS' COMPENSA'T`ION AND EMPLOYERS' LIABILITY INSURANCE POLICY <br />WC 99 03 04 (Ed. 7-05) <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 dam is <br />indicated below. <br />(fhefollowing "atncblvg elauee"aeed bee Plntdwilgwhen this evdvmemevtia lseaed subsequent w pespemdoa of'he laity.) <br />This endorsement, effective on 4/30/2014 at 12:01 A. I. standard time, forms a part of <br />(DATE') <br />Polley No. 71750505 of the FEDERAL INSURANCE COMPANY <br />(NAME OF INSURANCE COMPANY) <br />Issued to BEST BEST & KRIEGER LLP <br />Endorsement No. <br />We have the right to recover our payments from anyone liable for an injury coveted by this policy, We Will net enforce our right <br />against the person or Organization named in the Schedule. The additional premium for the blankat waiver offered by this endorsement <br />shall be 1.00% of total California premlutn <br />Schedule <br />Person or Organization job Description <br />BLANKET WAIVER- ANY PERSON OR ORGANIZATION FOR ALL CALIFORNIA OPERATIONS <br />WHOM TIME NAMED INSURED HAS AGREED BY WRITTEN <br />CONTRACT TO FURNISH THIS WAIVER <br />WC 99 03 04 MD. 7-08 <br />Attachment Code: D466017 <br />Certificate ID : 11767171 <br />Pagel of 1 <br />