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INSURED: C BELOW, INC. <br />TRAVELERS <br />POLICY DATES: 12/18/2017 TO <br />12/18/2018 <br />WORKERS COMPENSATION <br />AND <br />EMPLOYERS LIABILITY POLICY <br />ENDORSEMENT WC 99 03 76 (A) - 001 <br />POLICY NUMBER: XJUB-4181T277 <br />WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS <br />ENDORSEMENT — CALIFORNIA <br />(BLANKET WAIVER) <br />We have the right to recover our payments from anyone liable for an injury covered by this <br />policy. We will not enforce our right against the person or organization named in the Schedule. <br />You must maintain payroll records accurately segregating the remuneration of your employees <br />while engaged in the work described in the Schedule. <br />The additional premium for this endorsement shall be 3 % of the California workers' <br />compensation premium otherwise due on such remuneration. <br />Schedule <br />Person or Organization Job Description <br />ALL PERSONS OR ORGANIZATIONS <br />THAT ARE PARTIES TO A CONTRACT <br />THAT REQUIRES YOU TO OBTAIN <br />THIS AGREEMENT, PROVIDED YOU <br />EXECUTED THE CONTRACT BEFORE <br />THE LOSS. <br />REVIEWED BY: EUNICE HEREDIA (P OF ) <br />