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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY <br />WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT—CALIFORNIA <br />WC 04 03 06 <br />(Ed. 4-84) <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 the Schedule. (This agreement applies only to the extent that <br />you 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 <br />work described in the Schedule. <br />The additional premium for this endorsement shall be 2% of the California workers' compensation premium <br />otherwise due on such remuneration. <br />Person or Organization <br />Schedule <br />Job Description <br />Any person or organization that you are required to waive Jobs performed for any person or organization that you <br />rights of recovery against in a written contract or agreement. have agreed with in a written contract to provide this <br />agreement. <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 Effective7/1/2021 Policy No.PSW0004954 <br />InsuredAGA Engineers, Inc. Insurance Company <br />RLI Insurance Company <br />Countersigned By <br />Endorsement No. <br />©1998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved. <br />[/R�wEwED� 6M�Rovm By. <br />rnFwM.l R. VAWAI <br />�� Ruk Management Analyst <br />63664414 1 7/21-22 G /AVTO/EXCESS/WC/PL Blanket Endts I (AVC) Donna Esgnivel 1 8/20/2021 3:43:33 PM (PUT) [ Page 6 0` 6 <br />