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WORKERS'COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY WC 04 03 06 <br /> Gregg Drilling,LLC 08/01/2019 (Ed. 4-84) <br /> WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT- <br /> CALIFORNIA <br /> We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not <br /> enforce our right against the person or organization named in the Schedule. (This agreement applies only to the <br /> extent that 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 <br /> the work described in the Schedule. <br /> The additional premium for this endorsement shall be % of the California workers' compensation pre- <br /> mium otherwise due on such remuneration. <br /> Schedule <br /> Person or Organization Job Description <br /> ALL PERSONS AND/OR ALL CALIFORNIA LOCATIONS <br /> ORGANIZATIONS <br /> THAT ARE REQUIRED <br /> BY WRITTEN CONTRACT <br /> OR AGREEMENT WITH <br /> THE INSURED,EXECUTED <br /> PRIOR TO THE <br /> ACCIDENT OR LOSS, <br /> THAT WAIVER OF <br /> SUBROGATION BE <br /> PROVIDED UNDER THIS <br /> POLICY FOR WORK <br /> PERFORMED BY YOU FOR <br /> THAT PERSON AND/OR <br /> ORGANIZATION <br /> WC 252(4-84) <br /> WC 04 03 06(Ed.4-84) Page i of 1 <br /> Policy No.: <br /> 51017096 19-20 GL-AIrT0-WC-XS-CPL-PROF Phyllis Johnson 9/6/2019 2:23:12 PM (PVC) Page 14 of 14 <br />