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Attachment Code:D565978 Certificate ID: 16059509 <br /> WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY <br /> WC 04 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 not enforce our <br /> right against the person or organization named in the Schedule. (This agreement applies only to the extent that you <br /> 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 work <br /> described in the Schedule. <br /> The additional premium for this endorsement shall be_*_% of the California workers' compensation premium otherwise <br /> due on such remuneration. <br /> Person or Organization Job Description <br /> WHERE YOU ARE REQUIRED BY WRITTEN CONTRACT TO <br /> OBTAIN THIS AGREEMENT FROM US, PROVIDED THE <br /> CONTRACT IS SIGNED AND DATED PRIOR TO THE DATE OF <br /> LOSS TO WHICH THIS WAIVER APPLIES. IN NO INSTANCE <br /> SHALL THE PROVISIONS AFFORDED BY THIS <br /> ENDORSEMENT BENEFIT ANY COMPANY OPERATING <br /> AIRCRAFT FOR HIRE. <br /> *The premium charge for this endorsement shall be 2% of the premium developed in the State of California, but not less <br /> than $500 policy minimum premium. <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 2/1/2024 Policy No. T10220329 Endorsement No. 23 <br /> Insured Rincon Consultants, Inc. Policy Effective Date 2/1/2024 <br /> Insurance Company StarStone National Insurance Company <br /> i <br /> Countersigned By <br /> r <br /> WC 04 03 06 <br /> (Ed. 4-84) �ManagemettDivision <br /> "Mi. REVIEWED&APPROVED BY: <br /> ©1998 by the Workers'Compensation Insurance Rating Bureau of California.All rights reserved. 144 fri¢A1:ev4 4 <br /> Risk Management Specialist <br />