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p <br /> m ortant �Z%Berkshire Hathaway <br /> Information ft <br /> Insunce <br /> GUARDCom ranies <br /> Agency <br /> Xanadu Services System INC BUILDERS &TRADESMENS INSURANCE SERVICE INC <br /> 752 S Windsor Blvd 6610 Sierra College Blvd <br /> Los Angeles, CA 90005-3785 Rocklin, CA 95677 <br /> Changes to Your Workers' Compensation Policy <br /> with NorGUARD Insurance Company <br /> Policy Number XAWC796139 <br /> Policy Period <br /> From April 2, 2026 to April 2, 2027, 12:01 AM, standard time at the insured's mailing address. <br /> Party Requesting the Change and Type of Endorsement <br /> The Agent - Added Blanket Waiver of Subrogation effective 04/02/2026 <br /> State: CA; <br /> New CA Estimated Annual Premium 5,525 <br /> Premium change: $ 140.00 <br /> State Fees: $ 5.00 <br /> Total change: $ 145.00 <br /> This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. <br /> (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) <br /> Endorsement Effective See Above Policy No. XAWC796139 Endorsement No. 2 <br /> Insured Xanadu Services System INC Premium $145 <br /> Insurance Company Countersigned by <br /> NorGUARD Insurance Company <br /> Thank You Again for Choosing Berkshire Hathaway GUARD Insurance Companies! <br /> Call Customer Service at 800-673-2465 with any questions. <br /> Endorsement <br /> WC 99 00 13 <br />