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PINNn, COL <br />ASSURANCE <br />Green Play LLC <br />1021 E South Boulder Road <br />Suite N <br />Louisville, CO 80027 <br />ENDORSEMENT: Blanket Waiver of Subrogation <br />7501 E. Lowry Blvd. <br />Denver, CO 80230-7006 <br />303.361.4000 / 800.873.7242 <br />Pinnacoi.com <br />NCCI #: WC000313B <br />Policy #: 4019301 <br />Diversified Commercial Insurers <br />PO Box 461173 <br />Aurora, CO 80046 <br />(303)693-9343 <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 />This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. <br />SCHEDULE <br />To any person or organization when agreed to under a written contract or agreement, as defined above <br />and with the insured, which is in effect and executed prior to any loss. <br />Effective Date:April 23, 2019 Expires on: May 1, 2020 <br />Pinnacol Assurance has issued this endorsement April 23, 2019 <br />Page 1 of 1 P MCCRACKC - Underwriter 04/23/2019 07501 9:36:31 Lowry 4019301 53735 19 B02 359-8 6 <br />