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WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY <br /> WC 0❑03 0❑1111d. ❑1111❑❑ <br /> WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT- <br /> CALIFORNIA <br /> This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a <br /> different date is indicated below. <br /> the following -attaching clause-need be completed only when this endorsement is issued subsequent to preparation of the policy.- <br /> This endorsement, effective on 10/01/2025 at 12:01 A.M. standard time, forms a part of <br /> DAT-- <br /> Policy ❑o. WC 5646573 -02 ❑ndorsement ❑o. <br /> of the Zurich American Insurance Company <br /> CAME]OF IDSORADCD COMPA-Y- <br /> issued to Leed Electric, Inc. <br /> Premium if any-- <br /> Authorized Representative <br /> We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not <br /> enforce our right against the person or organization named in the Schedule. :This agreement applies only to the <br /> event that you perform wor❑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 <br /> the wor❑described in the Schedule. <br /> The additional premium for this endorsement shall be ❑ of the California worEOrs❑compensation pre[] <br /> mium otherwise due on such remuneration. <br /> Schedule <br /> Person or Organization Job Description <br /> ALL P❑RSO❑S A❑DOOR ALL CA OP❑RATIO❑S <br /> ORGA❑IZATIO❑S THAT AR❑ <br /> R❑Q❑IR❑D BY WRITT❑❑ CO❑TRACT <br /> OR AGR❑❑M❑❑T WITH TH❑ 111S❑R❑D, <br /> ❑❑❑C❑T❑D PRIOR TO TH❑ACCID❑❑T <br /> OR LOSS, THAT WAIV❑R OF <br /> S❑BROGATIO❑ B❑ PROVID❑D ❑❑D❑R <br /> THIS POLICY FOR WORD P❑RFORM❑D <br /> BY YO❑ FOR THAT P❑RSO❑A❑DOOR <br /> ORGA❑IZATIO❑ <br /> WC 2E2 1111mo <br /> WC 01103 0❑mod. 0=0 Page 1 of 1 <br />