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TRAVELERS WORKERS COMPENSATION <br />.AND <br />EMPLOYERS LIABILITY POLICY <br />ENDORSEMENT WC 99 03 76 ( A) — <br />POLICY NUMBER: UB -4E963854-17 <br />WAIVER OF OUR RICHT TO RECOVER FROM OTHERS <br />ENDORSEMENT - CALIFORNIA <br />(BLANKET WAIVER) <br />We have the right to recover our payments from anyone liable for an Injury covered by this policy. We will not <br />enforce our right against the person or organization named in the Schedule, <br />The additional premium for this endorsement shall be % of the California workers' compensation pre- <br />mium, <br />Schedule <br />Person or Organization Job Description <br />Any person or organization requiring waiver of subrogation by written contract for work <br />performed by or on the insured's behalf <br />This endorsement changes the policy to which it is attached and Is effective on the date issued unless otherwise <br />stated, <br />(The Information below is required only when this endorsement Is Issued subsequent to preparation of <br />the policy.) <br />Endorsement Effective 05/19/2016 <br />Insured Tanko Street Lighting, Inc. <br />Insurance Company <br />Travelers Property Casualty Co of America <br />Policy No, us -4E963854-16 Endorsement No, <br />Premium <br />DATE OF ISSUE: - - ST ASSIGN: <br />Countersigned by <br />Page 1 of 1 <br />REVIEWED BY EUNICE HEREDIA (PG 1o�l: <br />