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C'NA <br /> Waiver Of Subrogation (Workers Compensation Policy) <br /> LANKET W!. ® ..,OLt r ' w . O. ®, R FROM O • E <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-Employers'Liability <br /> 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 you <br /> perform work under a written contract that requires you to obtain this agreement from us.) <br /> PREMIUM CHARGE-Refer to the Schedule of Operations <br /> The charge will be an amount to which you and we agree that is a percentage of the total standard premium for California <br /> exposure.The amount is Blanket Waiver of Subrogation Percentage Charge%. <br /> All other terms and conditions of the policy remain unchanged. <br /> This endorsement,which forms a part of and is for attachment to the policy issued by the designated Insurers,takes effect on <br /> the Policy Effective date of said policy at the hour stated in said policy, unless another effective date(the Endorsement Effective <br /> Date)is shown below,and expires concurrently with said policy unless another expiration date is shown below. <br /> Form No:G-19160-B(11-1997) <br /> Endorsement Effective Date:9/1/24 Endorsement Expiration Date: 9/1/25 Policy No:7034395505/7034395522 <br /> Endorsement No: 1 Policy Effective Date:9/1/24 <br /> ©Copyright CNA All Rights Reserved. <br /> Risk ManagemenEDivisian <br /> REVIEWED&APPROVED 8v: <br /> /14deZg Maud. <br /> i® <br /> Risk Management Specialist <br />