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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 />The additional premium for this endorsement shall be 0 % of the California workers' compensation <br />premium otherwise due on such remuneration. <br />Schedule <br />Person or Organization <br />THE CITY OF REDWOOD CITY <br />C/O ENGINEERING DIVISION <br />1017 MIDDLEFIELD RD. <br />REDWOOD CITY CA 94061 <br />The charge for this endorsement is $ 250 <br />Job Description <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 07/21/2025 <br />Policy No. EIG 5573371 01 <br />Issued to CURRY VILLAGE FOODS, INC <br />Premium $38,691 <br />Countersigned at <br />at 12:01 AM standard time, forms a part of <br />Of the EMPLOYERS PREFERRED INS. CO. <br />on <br />Carrier Code 00920 <br />By: <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.2026.022/Zareen's Restaurant (2039 Broadway) (Page 21 of 31) <br />