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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY MWC 1400 05 10 <br />Includes copyrighted material of National Council on Compensation Insurance with its permission <br />Copyright 1983 National Council on Compensation Insurance.Page 2 of 2MWC14000510 <br />BLANKET 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 enforce our <br />right against any 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 />You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the <br />work described in the Schedule. <br />This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. <br />Schedule <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 />Blanket Waiver <br />Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. <br />Premium: <br />The additional premium charge for this endorsement shall be 3 percent of the California Workers’ Compensation <br />premium otherwise due subject to a minimum premium of $750 per policy. <br />Endorsement Effective: 04/20/2025 Endorsement No. <br />Insurance Company: Markel Insurance Company Countersigned by __________________________________ <br />Premium $(See Attached)Insured: SCI CONSULTING GROUP (A CORP.) <br />Policy No. MWC0003533-15 <br />2. <br />1. <br />Docusign Envelope ID: 44B46978-8C9D-4351-9282-8253FD108A26