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<br />WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 <br />(Ed. 04-84) <br />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 <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 />You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the <br />work described in the Schedule. <br />The additional premium for this endorsement shall be 5%of the California workers'compensation premium <br />otherwise due on such remuneration. <br />Schedule <br />Person or Organization Job Description <br />The City of Pleasanton, its officers, employees and agents All locations as required by written contract or <br />agreement <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:07/01/2023 Policy No.: 100 0004228 Endorsement No.: <br />Insured:W estCoastArborists,Inc. <br />Insurance Company: Starr Specialty Insurance Company Countersigned by: <br />WC 04 03 06 <br />(Ed. 04-84) <br />Page 1 of 1 <br />DocuSign Envelope ID: 6F426B95-B790-44F8-8482-13687091F231