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THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />WAIVER OF OUR RIGHT TO RECOVER FROM <br />OTHERS ENDORSEMENT - CALIFORNIA <br />Policy Number: 76 WEG GB1737 Endorsement Number: 1 <br />Effective Date: 11/13/18 Effective hour is the same as stated on the Information Page of the policy. <br />Named Insured and Address: PARTNERS IN CONTROL, INC. <br />210 GODDARD <br />IRVINE CA 92618 <br />We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our <br />right against the person or organization named in the Schedule. (This agreement applies only to the extent that you <br />perform work under a written contract that requires you to obtain this agreement from us.) <br />You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work <br />described in the Schedule. <br />The additional premium for this endorsement shall be % of the California workers' compensation premium otherwise due <br />on such remuneration. <br />SCHEDULE <br />Person or Organization Job Description <br />Blanket Coverage <br />REVIEWED g APPROVED <br />13y Risk MANAQCmENr DivisiON <br />-3 S 1 ' �0 <br />FRANCINE R. VILLAREAL <br />Countersigned by <br />Authorized Representative <br />Form WC 04 03 06 (1) Printed in U.S.A. <br />Process Date: 10/09/18 Policy Expiration Date: 11/13/19 <br />