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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY 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 per- <br /> form 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 <br /> work described in the Schedule. <br /> The additional premium for this endorsement shall be 0 . 02 0 % of the California workers'compensation premium <br /> otherwise due on such remuneration. <br /> Schedule <br /> Person or Organization <br /> Blanket Waiver of Subrogation <br /> Job Description <br /> As Required by Written Contract <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 Date:07/17/2024 Policy No. HSW277152824 Endorsement No. <br /> Policy Effective Date: 07/17/2024 to 07/17/2025 Premium $ <br /> Insured: Jesse Cochran. <br /> DBA: Advantage Event Solutions <br /> Carrier Name/Code: State National Insurance Company, Inc . <br /> Countersigned by <br /> WC 04 03 06 <br /> (Ed. 4-84) <br /> Page 1 of 1 <br /> PO[_#HSW277152824 <br />