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WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY <br />WC 99 03 04 (Ed. 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 <br />different date is indicated below. <br />(The following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy.) <br />This endorsement, effective on <br />Policy No. (20)7174-98-12 <br />issued to INFOSEND INC <br />Endorsement No. <br />02/01/19 at 12:01 A. M. standard time, forms a part of <br />(DATE) <br />of the FEDERAL INSURANCE COMPANY <br />(NAME OF INSURANCE COMPANY) <br />Authorized Representative <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. The additional premium for the blanket waiver <br />offered by this endorsement shall be 1.00 % of total California premium. <br />Schedule <br />Person or Organization <br />BLANKET WAIVER - ANY PERSON OR ORGANIZATION <br />FOR WHOM THE NAMED INSURED HAS AGREED BY <br />WRITTEN CONTRACT TO FURNISH THIS WAIVER <br />Job Description <br />ALL CALIFORNIA OPERATIONS <br />312//0-0/ q <br />Ff tpRQVED <br />r je lcq� <br />-70 <br />WC 99 03 04 (Ed. 7-08) <br />