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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 not <br />enforce our right against the person or organization named in the Schedule. (This agreement applies only to the <br />extent that 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 <br />the work described in the Schedule. <br />The additional premium for this endorsement shall be 2 <br />premium otherwise due on such remuneration. <br />Person or Organization <br />Schedule <br />% of the California workers' compensation <br />Job Description <br />Any person or organization for whom the Named <br />Insured has agreed by written contract executed prior <br />to loss. <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 2/1/2025 Policy No. 9018556001 Endorsement No. <br />Insured Syufy Enterprises, LP Insurance Company Sentry Casualty Company <br />Countersigned by <br />WC 04 03 06 <br />(Ed. 4-84) <br />©1998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved. <br />From the WCIRB's California Workers' Compensation Insurance Forms Manual ©2001. <br />9018556001 <br />Sentry Casualty Company <br />1 00002 0000000000 24030 0 N <br />alb626be-712d-4e22-aead-46c7cf4d0651 <br />Page 1 of 1 <br />01/30/2024 <br />