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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY VVC39O034 <br />WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT -BLANKET <br />VVohave the righttor000varourpayments from anyone liable for aninjury oovormdbvthhsooioy.VVewiUnot <br />enforceourhghtagainettheporoonororganizadonnamodintheSohedu|e.Olhieagnaementopp|ieson|ytothe <br />extent that you perform work under a written contract that requires you to obtain this agreement from us). <br />The additional premium for this endorsement shall be 3% of the total California Workers' Compensation premium <br />otherwise due. <br />Schedule <br />Person or Organization Job Description <br />ANY PERSON OR ORGANIZATION ALL CALIFORNIA OPERATIONS. <br />FOR VVH{}M THIS WAIVER IS <br />REQUIRED. <br />Policy Number: VVVE5O3O35401 Insured: Crosstown Electrical & Data Inc <br />Endorsement Effective: 0/3/2U1O Coverage Provided by: Insurance Company Ofthe West <br />Issue Date: 5/27/2016 Countersigned by: <br />VVCS9O834 <br />