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CNA (Ed. 1 11/97) <br />(Ed. 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 <br />(Ed. 11/97) <br />Insured Name: MARK THOMAS & COMPANY, INC. <br />Policy No: 6078951418 <br />Effective Date: 09/15/2021 <br />w. IhNEWm 6 & A� BY: <br />Yi :Br:ago <br />am,nt„wgenm.uR�wae� <br />66237687 1 NUI -1 121-22 YasCer COI I Prabhjot Kaui 11/12/2022 8:54:25 AM (PST) I Page 8 of 11 <br />