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Workers' Compensation and Emolovers' Llabillty Policv Named Insured BARRETT BUSINESS SERVICES, INC. UCIF Endorsement Number DEKRA -UTE INDUSTRIES, INCORPORATED 8100 NE PARKWAY DRIVE, STE. 200 VANCOUVER WA 98662 Policy Number Symbol: RWC Number: 048533085 Policy Period Effective Date of Endorsement 10-01 -2015 TO 10-01 -2016 10-01 -2015 Issued By (Name of Insurance Company ACE AMERICAN INSURANCE COMPANY Insert ft Policy number, The remainder of the Inlormafton Is to be completed when this endorsement is Issued subs vent to the preparsuen of the policy, CALIFORNIA WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement applies only to the Insurance provided by the policy because California Is shown in Item 3.A. of the Information Page. We have the right to recover our payments from anyone liable for an Injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule, but this waiver applies only with respect to bodily Injury arising out of the operations described in the Schedule, where you are required by a written contract to obtain this waiver from us. You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described In the Schedule. Schedule 1. ( ) Specific Walver Name of person or organization: ( X) Blanket Waiver Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. 2. Operations: ALL CALIFORNIA OPERATIONS 3. Premium: The premium charge for this endorsement shall be 2.0 percent of the California premium developed on payroll In connection with work performed for the above person(s) or organization(s) arising out of the operations described. 4. Minimum Premium: $0 Aathadwd Agent WC 99 03 22