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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY <br />WC 04 03 06 <br />WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT—CALIFORNIA <br />(Ed. 04-84) <br />We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right <br />against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work <br />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 2 % of the California workers' compensation premium otherwise due on <br />such remuneration. <br />Schedule <br />Person or Organization Job Description <br />Where required by written agreement signed prior to loss All California Operations. <br />This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. <br />(The information below is required only when this endorsement is issued subsequent to preparation of the policy.) <br />Endorsement Effective 07/01/2021 Policy No. WEC300156701 Endorsement No. <br />Insured Insurance Company <br />Ocean Blue Environmental Services, Inc. XL Specialty Insurance Company <br />Countersigned By <br />WC 04 03 06 <br />(Ed. 04-84) Copyright 1984 Workers' Compensation Insurance Rating Bureau of California. All Rights Re: <br />oRaN� <br />3 <br />Risk Mwag merdDivisian <br />REVIEWED & APPROVED BY.- <br />Risk Management Analyst <br />