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THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />Countersigned by <br />Authorized Representative <br />Form WC 04 03 06 (1) Printed in U.S.A. <br />Process Date:04/09/25 Policy Expiration Date:04/12/26 <br />WAIVER OF OUR RIGHT TO RECOVER FROM <br />OTHERS ENDORSEMENT - CALIFORNIA <br />Policy Number:57 WEC BR2BEP Endorsement Number: <br />Effective Date:04/12/25 Effective hour is the same as stated on the Information Page of the policy. <br />Named Insured and Address:Pakpour Consulting Group, Inc. <br />6601 OWENS DR <br />PLEASANTON CA 94588 <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 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 />You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work <br />described in the Schedule. <br />The additional premium for this endorsement shall be 2 % of the California workers' compensation premium otherwise due <br />on such remuneration. <br />SCHEDULE <br />Person or Organization Job Description <br />Any person or organization for whom you are required by written contract or agreement to obtain this waiver of rights from <br />us <br />Named Insured - Pakpour Consulting Group, Inc.Policy Number - 57 WEC BR2BEP <br />Docusign Envelope ID: AD76C2F9-B3FA-4318-8F3F-0E57966D45A3