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Workers Compensation And Employers Liability Insurance <br />CNAPolicy Endorsement <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 2%. <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 />APPROVED <br />By Cynthia Mora at 3:1 S pm, Oct 30, 2024 <br />Form No: G-19160-B (11-1997) Policy No: WC 2 74978630 <br />Endorsement Effective Date: Endorsement Expiration Date: Policy Effective Date: 10/01/2024 <br />Endorsement No: 6; Page: 1 of 1 Policy Page: 53 of 83 <br />Underwriting Company: Valley Forge Insurance Company, 161 N Franklin St, Chicago, IL 60606 <br />CNA All Riohts Reserved. <br />