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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY <br />WC 99 0410B <br />(Ed. 9-14) <br />WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA <br />BLANKET BASIS <br />We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce <br />our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you <br />perform work under a written contract that requires you to obtain this agreement from us.) <br />The additional premium for this endorsement shall be 2% of the total manual premium otherwise due on such <br />remuneration. The minimum premium for this endorsement is $350. <br />This agreement shall not operate directly or indirectly to benefit anyone not named In the Schedule. <br />SCHEDULE <br />BLANKET WAIVER <br />Person/Organization Blanket Waiver — Any person or organization for whom the Named Insured has <br />agreed by written contract to furnish this waiver. <br />Job Description <br />All CA Operations <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 po0ey.) <br />Endorsement Effective 09/01/2019 <br />Insured Houston & Harris PCS, Inc. <br />Insurance Company Cypress Insurance Company <br />WC 99 0410B <br />(Ed. 9-14) <br />POlicyNO. HOWC013672 Endorsement No. <br />Premium S <br />REVIEWED & APPROVED <br />By Risk MANAGEMENT DIVISION <br />1 202 <br />h (ANCINE R. VILLAREAL <br />