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QBE- <br /> THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br /> POLICY CHANGES <br /> The following item(s): <br /> ❑ Insured Name ❑ Insured Mailing Address <br /> ❑ Policy Number ❑ Insured Legal Status/Business of Insured <br /> ❑ Effective/Expiration Date/Retroactive Date ❑ Premium Determination <br /> ❑ Payment Plan ❑ Self-Insured Retention or Deductible <br /> ❑ Additional Interested Parties ❑ Classification/Class Codes <br /> ❑ Limits/Exposure ❑ Underlying Insurance <br /> ❑ Covered Property/Location Description ® Added/Deleted Endorsement(s) or <br /> Exclusion(s) <br /> ❑ Rates/Scheduled Rating ❑ Mooring Location/Navigation <br /> Amends Schedule of Forms and Endorsements as follows: <br /> The following endorsement(s) or exclusion(s) are added: <br /> Waiver of Subrogation Endorsement <br /> The above amendments result in a change in the premium as follows: <br /> ® No ❑ To Be Adjusted Additional Premium Returned Premium Surcharge\Taxes <br /> Change At Audit $ $ $ <br /> All other terms, conditions and exclusions remain unchanged. <br /> This endorsement changes the policy to which it is attached and is effective on the date issued unless <br /> otherwise stated. <br /> (The information below is required only when this endorsement is issued subsequent to <br /> preparation of the policy.) <br /> Endorsement Effective:4/1/2025 Policy No.: LAW-21318-04 Endorsement No. 1 <br /> Insured: Carpenter, Rothans & Dumont, LLP Premium: <br /> Insurance Company: QBE Insurance Corporation <br /> Authorized Signature: <br /> LG-LPL-200025(08-18) © cm, 2018 Page 1 of 1 <br />