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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY VVCS9OG84 <br />WAIVER QFOUR RIGHT TQRECOVER FROM OTHERS ENDORSEMENT -BLANKET <br />VVohave the righttorecoverourpaymentnfnornanyone|iob|nforani juryoovormdbvUliaonicy.VVewiUnot <br />enforce our right against the person or organization named in the Schedule. (This agreement applies only to the <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 (}RG/\N|Z/\T|C)N ALL CALIFORNIA (]PER/\T|[>NG. <br />FOR WHOM THIS WAIVER IS <br />REQUIRED. <br />Policy Number: VVVE 5030354 02 Insured: Crosstown Electrical & Data Inc <br />Endorsement Effective: G/3/2O17 Coverage Provided by: Insurance Company ofthe West <br />Issue Date: 5/26/2017 Countersigned by: <br />WC80O834 <br />(Ed. 8-00) REVIEWED BY'i EUMCEHEREDIA(P.. 0.4 <br />