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Attachment Code:D679681 Master ID: 1566486,Certificate ID:22674129 <br /> CNA <br /> Workers Compensation And Employers Liability Insurance <br /> Policy Endorsement <br /> OF n JFRPM OTHERS <br /> This endorsement changes the policy tow ichitis attached. <br /> It is agreed that Park One- Workers' Compensation Insurance G. Recovery From Others and Part Two- <br /> Employers' LiabilityInsurance H. Recovery From Others are amended by adding the following: <br /> We will not enforce our rightto recover against persons or organizations, (This agreement applies only to the extent <br /> that you perform work under a written contract that requires you to obtain this agreement from us.) <br /> PREMIUM CHARGE - Referto the Schedule of Operations <br /> The charge will bean amount to which you and we agree that is a percentage of the total standard premium for <br /> California exposure.The amocint is 211/a, <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 atthe hour stated in said policy, unless another effective <br /> date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy unless another <br /> expiration date is shown below. <br /> Form No: G-19160-B (l!-i997) <br /> Endansement Effective Date: Endorsement Expiration Date: palicV EFF WC8 ate:7>4 669'2 <br /> Endor=ement No: Page: i of i I Rol icy EffectiveDate; 01+01}2025 <br /> Underwriting Company; The Continental Insuranre Companyr 151 N Fran4din St, Chicago, IL 6060J <br /> 9 Copyrigh rCNAAII Rig h is Rese ram. <br />