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WORKERS CCAFENSATION AND EMPLOYERS I kABILrrY INSURANCE POLICY WC 04 03 06 <br />led. 44A) <br />We hawo the nglit to recovar our payments from any rape for an injury Sewed by this Policy. Vve A -i It not enforce Our <br />right against the person or crgamalvi on named in the Schedule, (This wgreement applies only to the extent that you perform <br />y6rk under a wnden cert ant -hat, leoluass yo;,l to obtain this agreer-W from US <br />Ycu must maintain payroll records a=lrately negreglling the remurrelatiol I of yovr employees wrrye engaged in the, wok <br />descrAned in the Sv*dufe. <br />Toe additional pasmium for this endomovient Shall be _-ZD_% of the California workers' compensation premium OffieMiSa due <br />or such ner-nureration. <br />Schedule <br />pereon or orsemization Job Dortarlistimin <br />Any pemon or organization as requited by wntlen comiam <br />This endorsement changos the Wlicy is which it is alechrid and is effenlive. on "he date. issued unless otherwise stated <br />(The Information below is required only when this endorsement is issued subsequent to Prepaietron Of thq POIMM <br />Endo,somant Effeclike Dotal 111 1 2111 7 Poloy W CST60.19382 Endirzoineal No, �Qi <br />VH(li2017 OV01/2C18 PIM, (A <br />Policy Fffiv�*M calec: <br />insured Foddall Construction Corp. <br />Ovirrer Name 7 Code. Gonchmatlk Insurance. Company A <br />"C' 04 01106 <br />(Ed. 4-841 Coianrerslqned IkY <br />paqL of <br />