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WORKERS' COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 0306 <br />(Ed. 04-94) <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 right against the <br />person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract <br />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 described in the <br />Schedule. <br />The additional premium for this endorsement shall be _%of the California workers' compensation premium otherwise due on such <br />remuneration. <br />Person or Organization <br />All persons or organizations that are party to a <br />contract that requires you to obtain this <br />agreement, provided you executed the contract <br />before a loss <br />Schedule <br />Job Description <br />Job performed for any person or organization that you <br />have agreed with in a written contract to provide this <br />agreement. <br />APPROVED <br />By Cynthia Mora at 11:56 am, Dec 11, 2024 <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 11/20/2024 Policy No. PSWO004454 Endorsement No. <br />Insured BOA ARCHITECTURE Insurance Company RLI Insurance Company <br />