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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 <br />(Ed. 4-84) <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 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 />This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. <br />Schedule <br />WHERE REQUIRED BY AN EXECUTED WRITTEN CONTRACT IN ALL STATES WHERE APPLICABLE. <br />BLANKET WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS — CALIFORNIA <br />This endorsement changes the policy to which it is attached. <br />It is agreed that Part One - Workers' Compensation Insurance G. Recovery From Others and Part Two - <br />Employers' Liability Insurance H. Recovery From Others are amended by adding the following: <br />We will not enforce our right to recover against persons or organizations. (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 />PREMIUM CHARGE - Refer to the Schedule of Operations <br />The charge will be an amount to which you and we agree that is a percentage of the total standard premium for <br />California exposure. The amount is N/A. <br />All other terms and conditions of the policy remain unchanged. <br />This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers, takes <br />effect on the Policy Effective Date of said policy at the hour stated in said policy, unless another effective date (the <br />Endorsement Effective Date) is shown below, and expires concurrently with said policy unless another expiration date <br />is shown below. <br />This endorsement changes the policy to which it is attached 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 10/01/2021 <br />Insured Granite Construction Incorporated <br />WC 00 03 13 <br />(Ed. 4-84) <br />© 1983 National Council on Compensation Insurance. <br />Policy No. WC274978644 Valley Forge Insurance Co. <br />WC274978658 Transportation Insurance Co. <br />WC274978661 Transportation Insurance Co. <br />WC274978630 Valley Forge Insurance Co. <br />Countersigned by <br />Endorsement No. 000 <br />Premium $ <br />Risk Management DWisian <br />REVIEWED & APPROVED BY: <br />-�_r- Risk Management Spearalist <br />