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VV0����SC0KAPENSATHON <br />m om��Vm�m�n�mm=wJ AND <br />EMPLOYERS LIABILITY POLICY <br />ENDORSEMENT WC 99 03 76 ( A) — <br />POLICY NUMBER: na-xEoosus«-z« <br />WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS <br />ENDORSEMENT - CALIFORNIA <br />(BLANKET WAIVER) <br />We have the right to recover our payments fromanyone liable for an injury covered by this policy. We will not <br />enforce our right against the parson or organization named in the Schedule. <br />The additional premium for this endorsement mhmU be Y6 of the California workers' compensation pre- <br />mium. <br />Schedule <br />Person owOrganization Job Description <br />Any person or organization requiring waiver of subrogation by written contract for work <br />performed by or on the insured's behalf <br />This endorsement changes the policy towhich Kieattached and imeffective on the date issued unless otherwise <br />(The information bakoxv Is required only when this endorsement is issued subsequent to preparation of <br />the policy.) <br />Endorsement Effective 05/19/2016 Policy No. na-*u9e3854-16 Endorsement No. <br />Insured TankoStrea[ Lighting, Inc. Premium <br />Insurance Company Countersigned by <br />Travelers Property Casualty CoofAmerica <br />DATE QFISSUE: - - ST ASSIGN: Page 1 of I <br />