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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 dale is indicated below. <br />(The foIWMwhv'attactsrg clause' need be eomplated only when this endorsement Is Issued subsequent to preparation of the policy.) <br />This endorsement, effective on 02/01/16 at 12:01 A. M, standard time, forms a part of <br />(DATE) <br />Policy No. (17)7174-98.12 of the FEDERAL INSURANCE COMPANY <br />(NAME OF INSURANCE COMPANY) <br />Issued to INFOSEND INC <br />Endorsement No. <br />Aulhodzed 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'/a 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 />!reference Copy <br />WC 99 03 04 (Ed. 7-e8) <br />Job Description <br />ALL CALIFORNIA OPERATIONS <br />