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Policy# 7018042079 <br />CNA <br />�c10 1aa;r .IIr <br />This endorsement changes the policy to which it is attached. <br />It is agreed that Part O ne - Workers' Compensation I ns urance G. Recovery From Others and PartTwo - <br />Employers' Liability Insurance H. Recovery From Others are amended by addingthe 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 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 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-19160-B (11-1997) <br />Endorsement Effective Date: [TEFFDAT] Endorsement Expiration Date: <br />Endorsement No: [ENDSEQNUM] ; Page: a of b <br />Underwriting Company: UWCOMP, UWADDRI UWADDR2, UWCITY, UWSTATE UWZIP <br />REVIEWED 6 APPROVED BY: <br />A.ju AaN44 <br />Risk Management Specialist <br />O Copyright CNA All Rights Reserved. <br />