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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY VVC9QOG34 <br />(Ed. B'00) <br />WAIVER OFOUR RIGHT TORECOVER FROM OTHERS ENDORSEMENT -BLANKET <br />VVehave the right torecover our payments from anyone liable for eninjury ooveredbvthksooicy.VVewiUnct <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 ORORGANIZATION ALL CALIFORNIA OPERATIONS. <br />FOR WHOM THIS WAIVER IS <br />REQUIRED. <br />Policy Number: VVVE 503035402 |nSU[8d: CroGSiovvD BeC[hC8| @ Data Inc <br />Endorsement Effective: 8/3/2O17 Coverage Provided by: Insurance Company ofthe West <br />Issue Date: 5/26/2017 Countersigned by: <br />VVCSS0G34 <br />