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Attachment Code: D587584 Master TD: 1491 108, Certificate ID: 17506716 <br />CNA <br />POLICY NUMBER: 7014842810 <br />WORKERS COMPENSATION <br />BLANKET WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS <br />This endorsement changes the policy to which it is attached <br />It is agreed that Part One - Workers Compensation Insurance G. Recovery From Others and Part Two - <br />Employers Liability Insurance H. Recovery From Others are amended by adding the following: <br />We will not enforce our right to recover against persons or organizations. (This agreement applies only <br />to the extent that you perform work under a written contract that requires you to obtain this agreement <br />from us.) <br />PREMIUM CHARGE - Refer to the Schedule of Operations <br />The charge will be an amount to which you and we agree that is a percentage of the total standard <br />premium for California exposure. The amount is [Blanket Waiver of Subrogation Percentage Charge]. <br />All other terms and conditions of the policy remain unchanged <br />This endorsement, which forms a part of an is for attachment to the policy issued by the designated <br />Insurers, takes effect on the Policy Effective date of said policy at the hour stated in said policy, unless <br />another effective date (the Endorsement Effective Date) is shown below, and expires concurrently with <br />said policy unless another expiration date is shown below. <br />Form No. G-19160-B (11-1997) <br />Endorsement Effective Date: 05/01 /2021 <br />Policy Number: 7014842810 <br />cF RAManagementDMsian <br />Jy/\'x REVIEWED & APPROVED BY: <br />V"° <br />--� Risk janagement Analyst <br />