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INSURED: CAP Architecture <br />POLICY NUMBER: 5094854715 <br />EXPIRATION DATE: 05/18/2022 <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 <br />and Part Two — Employers' Liability Insurance H. Recovery From Others are amended by <br />adding the following: <br />We will not enforce our right to recover against persons or organizations. (This agreement <br />applies only to the extent that you perform work under a written contract that requires you to <br />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 <br />standard premium for California exposure. The amount is 2.%. <br />G-19160-B <br />(Ed. 11/97) <br />RmkM .g..wDn <br />�Fexmaru.9mmc a..w,iaoe <br />00 <br />