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HOME OFFICE <br />SAN FRANCISCO <br />ALL EFFECTIVE DATES ARE <br />AT 12:01 AM PACIFIC <br />STANDARD TIME OR THE <br />TIME INDICATED AT <br />PACIFIC STANDARD TIME <br />BROKER COPY <br />REP D1 <br />9124080-25 <br />RENEWAL <br />SP <br />8-80-21-93 <br />EFFECTIVE FEBRUARY 4, 2025 AT 12.01 A.M. PAGE 1 OF 1 <br />AND EXPIRING FEBRUARY 4, 2026 AT 12.01 A.M. <br />ENDORSEMENT AGREEMENT <br />WAIVER OF SUBROGATION <br />BLANKET BASIS <br />NATIONAL SAFETY SERVICES INC <br />5562 RESEARCH DR UNIT B <br />HUNTINGTON BEACH, CA 92649 <br />WE HAVE THE RIGHT TO RECOVER OUR PAYMENTS FROM ANYONE <br />LIABLE FOR AN INJURY COVERED BY THIS POLICY. WE WILL <br />NOT ENFORCE OUR RIGHT AGAINST THE PERSON OR <br />ORGANIZATION NAMED IN THE SCHEDULE. <br />THIS AGREEMENT APPLIES ONLY TO THE EXTENT THAT YOU <br />PERFORM WORK UNDER A WRITTEN CONTRACT THAT REQUIRES YOU <br />TO OBTAIN THIS AGREEMENT FROM US. <br />THE ADDITIONAL PREMIUM FOR THIS ENDORSEMENT SHALL BE <br />2.00% OF THE TOTAL POLICY PREMIUM. <br />SCHEDULE <br />PERSON OR ORGANIZATION <br />ANY PERSON OR ORGANIZATION <br />FOR WHOM THE NAMED INSURED <br />HAS AGREED BY WRITTEN <br />CONTRACT TO FURNISH THIS <br />WAIVER <br />JOB DESCRIPTION <br />BLANKET WAIVER OF <br />SUBROGATION <br />NOTHING IN THIS ENDORSEMENT CONTAINED SHALL BE HELD TO VARY, ALTER, WAIVE <br />OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS <br />POLICY OTHER THAN AS STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE <br />HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR <br />LIMITATIONS OF THIS ENDORSEMENT. <br />COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: FEBRUARY 5, 220025 <br />2572 <br />AUTHORIZED REPRESENT IVE PRESIDENT AND CEO <br />SCIF FORM 10217 (REV.7-2014) <br />OLD DP 217 <br />