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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 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 <br />engaged in the 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 />Work performed by <br />SCI CONSULTING GROUP (A CORP.) at: <br />4745 Mangels Blvd <br />Fairfield , CA 94534-4175 <br />Schedule <br />$0.00 <br />Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. <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 <br />policy.) <br />Endorsement Effective 04/20/2024 Policy No. MWC0003533-14 Endorsement No. <br />Insured: SCI CONSULTING GROUP (A <br />CORP.)Premium (See Attached) <br />Insurance Company: Markel Insurance Company <br />Countersigned by_____________________________ <br />WC040306 <br />(Ed. 04-84) <br />© 1998 by the Workers’ Compensation Insurance Rating Bureau of California. All rights reserved. <br />From the WCIRB’s California Workers’ Compensation Insurance Forms Manual © 2001 <br />20 of 38 <br />Docusign Envelope ID: CE088814-BCA6-46C6-A21B-7D7C037CCA3A