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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY MWC 1400 05 10 <br />BLANKET 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 right <br />against any person or organization named in the Schedule. (This agreement applies only to the extent that you perform work <br />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 work <br />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 for this endorsement shall be 3 percent of the California Workers' Compensation pre-mium <br />otherwise due subject to a minimum premium of $750 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: 07/15/2024 Policy No. EIG 5650385 00 Endorsement No. <br />Insured: Limon Redwood City Inc Premium (See Attached) <br />Insurance Company: Employers <br />Countersigned <br />Includes copyrighted material of National Council on Compensation Insurance with its permission <br />Copyright 1983 National Council on Compensation Insurance. <br />ATTY/AGR.2024.192/Limon (885 Middlefield Rd) (Page 32 of 33) <br />