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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.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 <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 />Schedule <br />Person or Organization Job Description <br />Any person or organization as required by written contract <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 Date: 07/28/2021 Policy No.: CST5021968 Endorsement No. <br />Policy Effective Dates: 07/28/2021 - 07/28/2022 <br />Insured: SLS Property Solutions, Inc. <br />Carrier Name / Code: Benchmark Insurance CompanyA <br />w.ItM...g..tlix� <br />WC040306 Countersigned by RLAe sARRRrnmErr. <br />(Ed. 04-84) lose pac -*H <br />RnkC1,-1 Aide <br />©Copyright 1984 National Council on Compensation Insurance, Inc. <br />