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WORKERS COMPENSATION AND EMPLOYERS I.,IABILITY INSURANCE POLICY WC d4 03 06 <br /> (Ed. 4-84) <br /> WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA <br /> We have the right to recover our payments from anyone liable for an injury covered by this policy.We will <br /> not enforce our right against the person or organization named in the Schedule. (This agreement applies <br /> only to the extent that you perform work under a wl1tten contract that requires you to obtain this <br /> agreement from us.) <br /> You must maintain payroll records accurately segregating the remuneration of your employees while <br /> engaged In the work described in the Schedule. <br /> The additional premium for this endorsement shall be 2_%of the Callfomla workers'compensation <br /> premium otherwise due on such remuneration. <br /> Schedule <br /> Person or organization Job Descrlptlon <br /> With respect to all employees subject to the <br /> workers' compensation laws of the state of <br /> California, any person or organization for whom <br /> the Named Insured has agreed by written <br /> contract to furnish this waiver. <br /> This policy Is subject to a minimum charge of$250 for the issuance of waivers of subrogation <br /> This endorsement chengee the policy to which it is attached and is effective on the date iSS4led unless otherwise stated. <br /> MIS information below Is roquired only when this endorsement 13 Iasued subsequent to pr"Brallon of the policy.) <br /> This endorsement,effective 03/0512025 at 12:01 AM standard time, forms a part of <br /> Policy No. EIG 4719708 04 Of the EMPLOYERS PREFERRED INS. 00. <br /> Carrier Code 00920 <br /> Issued to CV STRATEGIES INC Endorsement No. <br /> Premium $2,800 anq�� <br /> Cotintolsigned at on By' Authorized Repnmentetive <br /> WC 04 03 06 <br /> (Ed.4-84) a 1996 by tits Workers'Compensation Insurance mating 8uroau of Califomia.All rights reserved. <br />