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GJ ~.~ <br />Alaska National <br />INSURANCE COMPANY <br />WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT -- CALIFORNIA <br />We have the right to recover our payments from <br />anyone liable for an injury covered by this policy. We <br />will not enforce our right against the person or <br />organization named in the Schedule. (This agreement <br />applies only to the extent that you perform work under <br />a written contract that requires you to obtain this <br />agreement from us.) <br />You must maintain payroll records accurately segregating <br />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 <br />the California workers' compensation premium otherwise <br />due on such remuneration. <br />Schedule <br />Person or Organization <br />ALL PERSONS OR ORGANIZATIONS THAT ARE <br />PARTIES TO A CONTRACT THAT REQUIRES YOU <br />TO OBTAIN THIS AGREEMENT, PROVIDED YOU <br />EXECUTED THE CONTRACT BEFORE THE LOSS. <br />~O FQ~ <br />O~~ ~ <br />4'¢ <br />S.~pPCo ~eY <br />~1SP ~ City ~ <br />Psssta~t <br />Job Description <br />This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise <br />stated. The information below is required only when this endorsement is issued subsequent to preparation of <br />the policy. <br />Endorsement Effective 8!1/2008 <br />Insured Harris & Associates, Inc. <br />Policy No. 08HWD40007 <br />Endorsement No. <br />WC 04D3060484 <br />