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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 <br />not enforce our right against the person or organization named in the Schedule. (This agreement applies <br />only to the extent that you perform work under a written contract that requires you to obtain this <br />agreement from us.) <br />You must maintain payroll records accurately segregating the remuneration of your employees while <br />engaged in the work described in the Schedule. <br />Schedule <br />Person or Organization Job Description <br />The City of Redwood City its Council officers, <br />officials agents, employees, and volunteers. <br />1017 Middlefield Rd. <br />Redwood City, CA 94061 <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 />This endorsement, effective 07/30/2024 <br />Policy No. EIG5573371-00 <br />Issued to Curry Village Foods, Inc <br />Premium <br />Countersigned at <br />at 12:01 AM standard time, forms a part of <br />Of the EMPLOYERS COMPENSATION INS. CO <br />on <br />Carrier Code 00441 <br />0 <br />Endorsement No. <br />Authorized Representative <br />WC 04 03 06 <br />(Ed. 4-84) © 1998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved. <br />ATTY/AGR.2024.138/Curry Village Food (2039 Broadway) (Page 25 of 25) <br />