HOWARD E. NYHART CO., INC., THE - Laserfiche WebLink

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CALIFORNIA WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement applies only to the insurance provided by the policy because California is shown in Item 3.A. of the Information Page. We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule, but this waiver applies only with respect to bodily injury arising out of the operations described in the Schedule, where you are required by a written contract to obtain this waiver from us. You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. Schedule 1. (® ) Specific Waiver Name of person or organization CITY OF SANTA ANA,ITS CITY COUNCIL,OFFICERS,OFFICIALS,EMPLOYEES, AGENTS AND VOLUNTEERS (r_) Blanket Waiver Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. 2. Operations: ALL CALIFORNIA OPERATIONS The Howard E.Nyhart Company, Inc. 3 Premium: The premium charge for this endorsement shall be 1% percent of the California premium developed on payroll in connection with work performed for the above person(s)or organization(s)arising out of the operations described. 4. Minimum Premium: Authorized Representative This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 07-01-25 Policy No. 7177-08-19 Endorsement No. Insured MERCURY PARENT HOLDINGS,- INC Premium $ Incl. The Howard E.Nyhart Company,Inc. Insurance Company Chubb Indemnity Insurance Company Countersigned By WC 90 03 75(05/18) 96E0QF41 I xxc@021485GEeapnOolyO,l&yePrbfahilatityNa haf Negliexc1:201$/daBit®sfaa8RopgtsAan7R Oj6Pag92104oFM1@EDT) Page B of 8