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C�� Workers Compensation And Employers Liability Insurance <br /> Policy Endorsement <br /> BLANKET WAIVER I —j qwm <br /> OF t: 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 to the <br /> extent that you perform work under a written contract that requires you to obtain this agreement 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 premium for <br /> California exposure. The amount is 2%. <br /> All other terms and conditions of the policy remain unchanged. <br /> This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers, <br /> takes effect on the Policy Effective Date of said policy at the hour stated in said policy, unless another <br /> effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy <br /> unless another expiration date is shown below. <br /> Form No: G-191 Policy No: WC S 33451421 <br /> Endorsement Effective Date; Endorsement Expiration Date: Policy Effective Date: 10/01/2025 <br /> Endorsement No: ; Page: 1 of 1 Policy Page: <br /> Underwriting Company: American Casualty Company of Reading, Pennsylvan[I Underwriting Company:The Continental Casualty Company <br /> `'Copyright CNA All Rights Reserved. <br />