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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY <br />WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT—CALIFORNIA <br />WC 04 03 06 <br />(Ed. 4-84) <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 <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 />The additional premium for this endorsement shall be 5% of the California workers' compensation premium otherwise <br />due on such remuneration. <br />Schedule <br />Person or Organization Job Description <br />The City of Redwood City its Council, commissions, boards, committees, officers, employees <br />and agents <br />P.O. Box 391, Redwood City, CA 94064 <br />Job Information: Start Date: 07/23/2025 End Date: 07/23/2026 <br />2640-2644 Broadway St, Redwood City, CA 94063 <br />Description: Parklet/outdoor dining seating permit <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: 07/23/2025 Policy No.: WCNCC 313697 <br />Insured: <br />TW Bay, Inc. DBA Crouching Tiger Restaurant <br />Insurance Company: Countersigned by <br />National Casualty Company <br />Endorsement No.: <br />Premium $ INCL <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 />REV: 01-16-26 VR <br />ATTY/AGR.2026.008/TW Bay Inc. (2644 Broadway) (Page 22 of 32) <br />