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WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY <br />WC124 <br />(4-84) WC 00 03 13 <br />WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT <br />This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a <br />different date is indicated below. <br />(The following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy.) <br />This endorsement, effective on <br />Policy No. <br />(DATE) <br />of the <br />issued to <br /> Endorsement No. <br />Authorized Representative <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 />This agreement shall not operate directly or indirectly to benefit any one not named in the Schedule. <br />WC 124 (4-84) <br />WC00 0313 <br />Schedule <br />BLANKET WAIVER ANY PERSON OR <br />ORGANIZATION FOR WHOM THE <br />NAMED INSURED HAS AGREED BY <br />WRITTEN CONTRACT TO FURNISH <br />THIS WAIVER <br />Copyright 1983 National Council on Compensation Insurance. Page 1 of 1 <br />Nan Mckay and Associates, Inc. <br />7183-27-75 <br />09/25/2022 <br />Continental Casualty Company <br />73594336 | 22-23 PKG, E/O, WC + 23-24 EPL | Ginnie Bustamante | 3/27/2023 3:42:58 PM (PST) | Page 9 of 9 <br />DocuSign Envelope ID: 4B4F1847-3E9E-4EB7-86DF-20427FE372B2