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INSURED <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <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 Policy No. Endorsement No. <br />Insured Premium $ <br />Insurance Company <br /> Countersigned By <br />WPH 5052915 06 01/01/2026 <br />INSURANCE COMPANY OF THE WEST <br />FRONTIER BUILDING PRODUCTS INCL. <br /> <br />WC 99 06 34 <br />(Ed. 8-00) <br />WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 34 <br /> <br /> (Ed. 8-00) <br /> <br /> <br />WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - BLANKET <br /> <br /> <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 <br />you perform work under a written contract that requires you to obtain this agreement from us). <br /> <br />The additional premium for this endorsement shall be % of the total California Workers’ Compensation premium <br />otherwise due. <br /> <br />Schedule <br /> <br /> <br /> Person or Organization Job Description <br /> <br /> 2 <br />ANY PERSON OR <br />ORGANIZATION FOR <br />WHOM THE NAMED <br />INSURED IS REQUIRED <br />UNDER THE WRITTEN <br />CONTRACT TO FURNISH <br />THIS WAIVER. <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />Docusign Envelope ID: 747370BD-6177-8716-832E-12F48085F3BE