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~~ <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 />Job Description <br />ALL PERSONS OR ORGANIZATIONS THAT ARE <br />PARTIES TO A CONTRACT THAT REQUIRES YOU <br />TO 08TAIN THIS AGREEMENT, PROVIDED YOU <br />EXECUTED THE CONTRACT BEFORE THE LOSS. <br />za ~o~ <br />~ p,S <br />.c I~O~E ~Y/~~ <br />'~4 ~p g'(t)RCo rey <br />~F.. Ptt <br />S 5 a`~t G~t`1 <br />N-,_ <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 8/112008 <br />Insured Harris 8 Associates, Inc. <br />Policy No. OSHWD40007 <br />Endorsement No. <br />W C 04 03 O6 04 84 <br />