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Attachment Code : D639683 Master ID: 1533719, Certificate ID: 20838512 <br /> CNA Workers Compensation And Employers Liability Insurance <br /> Policy Endorsement <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 <br /> extent that you 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 <br /> California exposure. The amount is 3%. <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, <br /> takes effect on the Policy Effective Date of said policy at the hour stated in said policy, unless another <br /> effective date (the Endorsement Effective Date)is shown below, and expires concurrently with said policy <br /> unless another expiration date is shown below. <br /> \ / <br /> Risk MsmagemaitDivision <br /> Form No:G-19160-B(11-1997) REVIEWED&ArPaov®8v: <br /> Endorsement Effective Date: Endorsement Expiration Date: . "o I ry.? A1Z.a"cett <br /> Endorsement No:5:Page: 1 of 1 '�; <br /> 9 � ^� Risk Management Specialist <br /> Underwriting Company: The Continental Insurance Company. 151 N Franklin St,Chicago, IL 60606 / <br /> ©Copyright CNA All Rights Reserved. <br />