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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 03 01 <br />(Ed. 12-06) <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 <br />our right against any person or organization named In the Schedule. ('Chis agreement applies only to the extent that <br />you perform 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 />This agreement shall not operate directly or Indirectly to benefit anyone not named In the Schedule <br />SCHEDULE <br />1. Blanket Waiver <br />Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. <br />2. Premium: <br />The additional premium charge forth Is endorsement shall be 3016 percent of the California Workers' Compensation <br />premium otherwise due subject to a rninlmum premium of $730. per policy. <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: 1/4/2021 <br />Insured: Ross McDonald Company, Inc <br />Insurance Company: Markel Insurance Company <br />WC 99 03 01 <br />Policy No,: MWC 0000 425-11 Endorsement No.: <br />Pramium lCan Ahnval <br />Countersigned by: <br />59846570 1 ROSSM-4 121/22 - Per Project I MaryAnn Worman 11/25/2021 4:11:49 PM (PST) I Page 21 of 22 <br />