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G-19160-B <br />CNA (Ed. 11/97) <br />WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY <br />BLANKET WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS <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 extent that <br />you perform work under a written contract that requires you to obtain this agreement from us.) <br />PREMIUM CHARGE <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 />G-19160-B Page 1 of 1 <br />(Ed. 11 /97) <br />Insured Name: MARK THOMAS & COMPANY, INC. ^.,_ � "'er't IgMalan <br />Policy No: 6078951418 € Reae�D&APPROVE) BC <br />Effective Date: 09/1512020 e F4" K R. M644d <br />Risk Management Analyst '. <br />57714801 1 MARKT-1 120-21 Master certificate I Prabhjo[ Kaur 19/23/202. 2:39:21 PM (PDT) I Page 8 of 11 <br />