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EXCESS WORKERS' COMPENSATION AND EMPLOYER'S LIABILITY POLICY <br />Waiver of Our Right to Recover From Others Endorsement <br />We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce <br />our right against the person or organization named in this 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 />This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. <br />SCI3EDULE <br />State of California <br />Health and Human Services Agency <br />Department of Rehabilitation <br />721 Capitol Mall <br />Sacramento, CA 95814 <br />This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. <br />Company No. <br />Insured: Downey Unified School District <br />Policy Number: BMX-501-0008-002 <br />Endorsement Number: 3 <br />Endorsement Effective: 7/1/2020 Printed On: 1/25/2021 <br />Form No. WC 00 0313 <br />© Copyright 2002-2005 National Council on Compensation Insunmce, Inc. All Rights Resen <br />,�. <br />Welc ManugtmentDhieloa <br />BY: <br />`� Li•I,I IIIMr ` <br />(REVIEWED&M`P.ROJVtrm <br />{ IAdFM.l �. V+UF/wF.4 <br />'"'�— <br />auk Managemen[Flnalyst <br />