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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 04 10B <br />(Ed. 0.14) <br />WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT- CALIFORNIA <br />KANKET BASIS <br />We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce <br />our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you <br />perform work under a written contract that requires you to obtain this agreement from us.) <br />The additional premium for this endorsement shall be 2% of the total manual premium otherwise due on such <br />remuneration. The minimum premium for this endorsement is $350. <br />This agreement shall riot operate directly or Indirectly to benefit anyone not named In the Schedule. <br />SCHEDULE <br />BLANKET WAIVER <br />PsrsonlOrganizatlon Blanket Waiver—Any person or organization for whom the Named Insured has <br />agreed by written contract to furnish this waiver. <br />Joh Description Waiver Premium <br />All CA Operations <br />This endorsement changes the policy to which it Is attached and Is effective on the date issued unless otherwise stated. <br />(The Information below is required only when this endorsement is iesued subsequent to preparation of the policy.) <br />Endorsement Effective 4/1/2016 Policy No. MAVVC707693 <br />insured Mariposa Landscapes Inc. <br />Insurance Company Berkshire Hathaway 1-lomostate Ins Cc <br />Countersigned by <br />WC 99 04 11 <br />(Fd. 9.14) <br />23311991 1 t ItILP -01 I 19-1b }IC 1 811.9A Loadz 1 4/1/2016 1,01:90 em (PDT) I P6g6 2 OE 2 <br />Endorsemeat No, <br />Premium $ <br />