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CNA Workers Compensation And Employers Liability Insurance <br />Policy Endorsement <br />This endorsement changes the policy to which it is attached. <br />It is agreed that Part One - Workers' Compensation Insurance G. Recovery From Others and Part Two - <br />Employers' Liability Insurance H. Recovery From Others are amended by adding the following: <br />We will not enforce our right to recover against persons or organizations. (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 />PREMIUM CHARGE - Refer to the Schedule of Operations <br />The charge will be an amount to which you and we agree that is a percentage of the total standard premium for <br />California exposure. The amount is 2%. <br />All other terms and conditions of the policy remain unchanged. <br />This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers, <br />takes effect on the Policy Effective Date of said policy at the hour stated in said policy, unless another <br />effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy <br />unless another expiration date is shown below. <br />1 <br />f <br />i <br />REVIJWED & APPROVD <br />By R k MANAGEMENTDIVIS N <br />17 2020 <br />M. LAMBERT <br />Form No: G-19160-B 01-1997) Endorsement Expiration Date: 11/01/2020 Policy No: 6025002328 <br />Policy Effective Date: 11/0112019 <br />Underwriting Company: National Fire Insurance Cc of Hartford <br />60606 <br />0 r— ... :..6. rMA Aa o:.J.... o------ A <br />