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TRAVELERS <br />ONE TOWER SQUARE <br />HARTFORD CT 06183 <br />CHANGE EFFECTIVE DATE: 09-16-21 <br />WORKERS COMPENSATION <br />AND <br />EMPLOYERS LIABILITY POLICY <br />CHANGE DOCUMENT WC 99 99 98 ( A) <br />POLICY NUMBER: UB-6P363599-21-42-G <br />NCCI CO CODE: 13579 <br />INSURER: TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA <br />INSURED'S NAME: REDISTRICTING PARTNERS LLC <br />This change is issued by the Company or Companies that issued the policy and forms a part of the policy. It is <br />agreed that the policy is amended as follows: <br />An absence of an entry in the premium spaces below means that the premium adjustment, if any, will be made at <br />time of audit. <br />ADDITIONAL PREMIUM $ NIL <br />ADDITIONAL NON -PREMIUM $ NIL <br />RETURN PREMIUM $ NIL <br />RETURN NON -PREMIUM $ NIL <br />The following endorsement charge is added to the schedule: <br />STATE OF CA <br />LOCATION 001 <br />WAIVER OF SUBROGATION <br />SEE ATTACHED ENDORSEMENT <br />ESTIMATED <br />PREM. ANNUAL <br />CLASSIFICATION CODE BASIS RATE PREMIUM <br />SPECIFIC WAIVER <br />WAIVER CALCULATION IS <br />BASED ON CLASS CODE (S) <br />PREMIUM X RATE 0930 1 .05 0 <br />The following endorsement charge is added on the schedule: <br />STATE OF CA <br />LOCATION 001 <br />TERRITORY <br />WAIVER OF SUBROGATION <br />SEE ATTACHED ENDORSEMENT <br />ESTIMATED <br />DATE OF ISSUE: 09-23-21 HL CHANGE NO: 30 PAGE 1 OF 2 <br />POL. EFF. DATE: 01-31-21 POL. EXP. DATE: 01-31-22 <br />OFFICE: WALNUT CREEK CA 418 <br />PRODUCER: MCCLATCHY INS AGENCY HM867 <br />COUNTERS <br />Rink Managtment Di%isimt <br />IF%..ort. Mc'`C4A REVIEV;IEDSAPPRO MBY: <br />fnaw,6.r.e �'. VttP�l <br />®' Risk Management Analyst <br />