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DocuSign Envelope ID:5F7D644C-4F40-44B4-A535-1 E45695749C4 <br /> WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 04 10B <br /> (Ed. 9-14) <br /> WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA <br /> BLANKET BASIS <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 you <br /> perform work under a written contract that requires you to obtain this agreement from us.) <br /> The additional premium for this endorsement shall be 2% of the total manual premium otherwise due on such <br /> remuneration. The minimum premium for this endorsement is $350. <br /> This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. <br /> SCHEDULE <br /> BLANKET WAIVER <br /> Person/Organization Blanket Waiver— Any person or organization for whom the Named Insured has <br /> agreed by written contract to furnish this waiver. <br /> Job Description Waiver Premium <br /> All CA Operations <br /> This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. <br /> (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) <br /> Endorsement Effective 9/25/2019 Policy No. NAWC009748 Endorsement No. <br /> Insured Nan Mckay and Associates, Inc. <br /> Premium$ <br /> Insurance Company Berkshire Hathaway Homestate Ins Co <br /> Countersigned by <br /> WC 99 04 10B <br /> (Ed.9-14) <br /> 54533655 1 19-20 ALL LINES, 20-21 EPL I Ginnie Bustamante 1 3/10/2020 9:14:12 AM (PDT) I Page 9 of 9 <br />