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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 our right <br /> against the person Or organization named In the Schedule. (This agreement applies only To the extent that you perform work <br /> 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 on <br /> such remuneration. <br /> Schedule <br /> Person or Organization Job Description <br /> Any person or organization as required by written contract. <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 8/1/2018 Policy No. WWC3364623 Endorsement No. 0 <br /> Insured TSA Drilling Inc.(Corporation) Premium$ 10899 <br /> Insurance Company Wesco Insurance Company <br /> Countersigned by <br /> WC 04 03 06 <br /> (Ed.04-84) <br />