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TRAVELERS!' WORKERS COMPENSATION <br /> AND <br /> EMPLOYERS LIABILITY POLICY <br /> ENDORSEMENT WC 99 03 76 ( A)— <br /> POLICY NUMBER: UB2L553909 <br /> WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS <br /> ENDORSEMENT - CALIFORNIA <br /> (BLANKET WAIVER) <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. <br /> The additional premium for this endorsement shall be % of the California workers' compensation pre- <br /> mium. <br /> Schedule <br /> Person or Organization Job Description <br /> Any Person or organization for which the insured has agreed by written contract executed prior to <br /> loss to furnish this waiver. <br /> This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise <br /> stated. <br /> (The information below is required only when this endorsement is issued subsequent to preparation of <br /> the policy.) <br /> Insurance Company Countersigned by <br /> Travelers Property Casualty Company of America <br /> DATE OF ISSUE: 9/9/2025 Page 1 of 1 <br />