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STATE <br />COMPENSATION <br />INSURANCE FUND <br />HOME OFFICE <br />SAN FRANCISCO <br />ENDORSEMENT AGREEMENT <br />WAIVER OF SUBROGATION BLANKET BASIS <br />EFFECTIVE JUNE 5, 2024 AT 12.01 A.M. <br />ALL EFFECTIVE DA TES ARE <br />AT 12:01 AM PACIFIC <br />AND EXPIRING JUNE 5, 2025 AT 12.01 A.M. <br />ST ANDA RD TIME OR THE TIME INDICATED AT <br />PACIFIC STANDARD TIME <br />ORANGE COUNTY CHILDREN'S THERAPEUT 2215 N BROADWAY FL l SANTA ANA, CA 92706 <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 <br />ANY PERSON OR ORGANIZATION <br />FOR WHOM THE NAMED INSURED <br />HAS AGREED BY WRITTEN <br />CONTRACT TO FURNISH THIS <br />WAIVER <br />JOB DESCRIPTION <br />BLANKET WAIVER OF <br />SUBROGATION <br />REP Dl 9255171-24 RENEWAL SP 0-27-07-45PAGE 1 OF <br />NOTHING IN THIS ENDORSEMENT SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND <br />ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY <br />OTHER THAN AS ABOVE STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE <br />HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR <br />LIMITATIONS IN THIS ENDORSEMENT. <br />COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: <br />2572 ��q, JUNE 6, 2024 d-_. .J/1�� <br />PRESIDENT AND CEO <br />1 <br />SCIF FORM 10217 IREV.4-2018) OLD DP 217 <br />EXHIBIT 1 <br />  <br />  <br />City Council 10 – 110 7/1/2025