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ENDORSEMENT AGREEMENT <br />BROKER COPY <br />WAIVER OF SUBROGATION <br />BLANKET BASIS <br />HOME OFFICE <br />SAN FRANCISCO EFFECTIVE JUNE 30, 2021 AT 12.01 A.M. <br />ALL EFFECTIVE DATES ARE AND EXPIRING JUNE 30, 2022 AT 12.01 A.M. <br />AT 12:01 AM PACIFIC <br />STANDARD TIME OR THE <br />TIME INDICATED AT <br />PACIFIC STANDARD TIME <br />THE CAMBODIAN FAMILY <br />1626 E 4TH ST <br />SANTA ANA, CA 92701 <br />WE HAVE THE RIGHT TO RECOVER OUR PAYMENTS FROM ANYONE <br />LIABLE FOR AN INJURY COVERED BY THIS POLICY. WE WILL <br />NOT ENFORCE OUR RIGHT AGAINST THE PERSON OR <br />ORGANIZATION NAMED IN THE SCHEDULE. <br />THIS AGREEMENT APPLIES ONLY TO THE EXTENT THAT YOU <br />PERFORM WORK UNDER A WRITTEN CONTRACT THAT REQUIRES YOU <br />TO OBTAIN THIS AGREEMENT FROM US. <br />THE ADDITIONAL PREMIUM FOR THIS ENDORSEMENT SHALL BE <br />2.00% OF THE TOTAL POLICY PREMIUM. <br />SCHEDULE <br />PERSON OR ORGANIZAT <br />ANY PERSON OR ORGANIZATION <br />FOR WHOM THE NAMED INSURED <br />HAS AGREED BY WRITTEN <br />CONTRACT TO FURNISH THIS <br />WAIVER <br />DESCRIPTION <br />BLANKET WAIVER OF <br />SUBROGATION <br />9064986-21 <br />RENEWAL <br />SP <br />1-31-03-22 <br />PAGE 1 OF 1 <br />NOTHING IN THIS ENDORSEMENT CONTAINED SHALL BE HELD TO VARY, ALTER. WAIVE <br />OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS <br />POLICY OTHER THAN AS STATED. NOTHING ELSEWHERE IN THIS POLICY S <br />HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEM <br />LIMITATIONS OF THIS ENDORSEMENT. <br />COUNTERSIGNED AND ISSUED AT SSAANNFRFRANC�ISCOO: JULY <br />2572 <br />AUTHORIZED REPRESENT IVE <br />SC IF FORM 10217 IREV J-2014) <br />1, 2021 <br />_'''"•an•H, -` R6vIEwEo llMdon <br />Rkk Manegmient Supervisor <br />PRESIDENT AND CEO <br />OLD OF 217 <br />PRESIDENT AND CEO <br />OLD OF 217 <br />