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STATE <br /> * ENDORSEMENT AGREEMENT <br /> FUND WAIVER OF SUBROGATION <br /> BLANKET BASIS Page 1 <br /> HOME OFFICE <br /> SAN FRANCISCO 9124080-26 <br /> ALL EFFECTIVE DATES RENEWAL <br /> AT 12:01 AM PACIFIC <br /> STANDARD TIME ORTHE <br /> TIME INDICATED ATT February EFFECTIVE Feb 4, 2026 AT 12 : 01 AM. Southern <br /> PACIFIC STANDARD TIME AND EXPIRING February 4, 2027 AT 12 : 01 AM 8802193 <br /> NATIONAL SAFETY SERVICES INC <br /> 5562 RESEARCH DR <br /> UNIT B <br /> HUNTINGTON BEACH,CA 92649-1614 <br /> WE HAVE THE RIGHT TO RECOVER OUR PAYMENTS FROM ANYONE LIABLE FOR AN <br /> INJURY COVERED BY THIS POLICY. WE WILL NOT ENFORCE OUR RIGHT AGAINST <br /> THE PERSON OR ORGANIZATION NAMED IN THE SCHEDULE . <br /> THIS AGREEMENT APPLIES ONLY TO THE EXTENT THAT YOU PERFORM WORK UNDER <br /> A WRITTEN CONTRACT THAT REQUIRES YOU TO OBTAIN THIS AGREEMENT FROM US . <br /> THE ADDITIONAL PREMIUM FOR THIS ENDORSEMENT SHALL BE 2 . 00% OF THE <br /> TOTAL POLICY PREMIUM. <br /> SCHEDULE <br /> PERSON OR ORGANIZATION JOB DESCRIPTION <br /> ANY PERSON OR ORGANIZATION BLANKET WAIVER OF SUBROGATION <br /> FOR WHOM THE NAMED INSURED <br /> HAS AGREED BY WRITTEN <br /> CONTRACT TO FURNISH THIS <br /> WAIVER <br /> NOTHING IN THIS ENDORSEMENT SHALL BE HELD TO VARY,ALTER,WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, <br /> AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS ABOVE STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL <br /> BE HELD TO VARY,ALTER,WAIVE OR LIMIT THE TERMS,CONDITIONS,AGREEMENTS OR LIMITATIONS IN THIS ENDORSEMENT <br /> COUNTERSIGNED AND ISSUED AT SAN FRANCISCO:January 29,2026 <br /> AUTHORIZED REPRESENTATIVE PRESIDENT AND CEO <br /> 2572 <br /> SCIF FORM 10217(REV.4-2018) OLD DP 217 <br />