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ENDORSEMENT AGREEMENT BROKER COPY <br /> COMPeNSATION WAIVER OF SUBROGATION <br /> INSURANCE <br /> FUND BLANKET BASIS 9064986-24 <br /> RENEWAL <br /> NA <br /> HOME OFFICE 1-31-03-22 <br /> SAN FRANCISCO EFFECTIVE JUNE 30, 2024 AT 12.01 A.M. PAGE 1 OF 1 <br /> ALL EFFECTIVE DATES ARE AND EXPIRING JUNE 30, 2025 AT 12.01 A.M. <br /> AT 12:01 AM PACIFIC <br /> STANDARD TIME OR THE <br /> TIME INDICATED AT <br /> PACIFIC STANDARD TIME <br /> THE CAMBODIAN FAMILY <br /> 1626 E 4TH ST <br /> SANTA ANA, CA 92701 <br /> WE HAVE THE RIGHT TO RECOVER OUR PAYMENTS FROM ANYONE <br /> LIABLE FOR AN INJURY COVERED BY THIS POLICY. WE WILL <br /> NOT ENFORCE OUR RIGHT AGAINST THE PERSON OR <br /> ORGANIZATION NAMED IN THE SCHEDULE. <br /> THIS AGREEMENT APPLIES ONLY TO THE EXTENT THAT YOU <br /> PERFORM WORK UNDER A WRITTEN CONTRACT THAT REQUIRES YOU <br /> TO OBTAIN THIS AGREEMENT FROM US. <br /> THE ADDITIONAL PREMIUM FOR THIS ENDORSEMENT SHALL BE <br /> 2.00% OF THE TOTAL POLICY PREMIUM. <br /> SCHEDULE <br /> PERSON OR ORGANIZATION JOB DESCRIPTION <br /> ANY PERSON OR ORGANIZATION BLANKET WAIVER OF <br /> FOR WHOM THE NAMED INSURED SUBROGATION <br /> HAS AGREED BY WRITTEN <br /> CONTRACT TO FURNISH THIS <br /> WAIVER <br /> NOTHING IN THIS ENDORSEMENT CONTAINED SHALL BE HELD TO VARY, ALTER, WAIVE <br /> OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS <br /> POLICY OTHER THAN AS STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE <br /> HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR <br /> LIMITATIONS OF THIS ENDORSEMENT. <br /> COUNTERSIGNED AND ISSUED AT SAN FRANCISCO; JULY 2, 2024 <br /> 2572 <br /> AUTHORIZED REPRESENT IVE PRESIDENT AND CEO <br /> SCIF FORM 10217 (REV.7.2014) OLD DP 217 <br />