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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 89 06 00 B <br /> POLICY INFORMATION PAGE ENDORSEMENT <br /> Insured: eSentire America, Inc. Policy No: TWC4486819 <br /> Policy Period: 9/14/2024 to 9/14/2025 Endorsement No: 7 <br /> Carrier Name: Technology Insurance Company, Inc. Endmt Effective: 4/23/2025 <br /> Authorized Rep: <br /> The following item(s) <br /> q Insured's Name(WC 89 06 01) ❑ Item 3.13. Limits(WC 89 06 12) <br /> ❑ Policy Number(WC 89 06 02) ❑ Item 3.C.States(WC 89 06 13) <br /> r7 Effective Date(WC 89 06 03) N Item 3.D.Endorsement Numbers(WC 89 0614) <br /> ❑ Expiration Date(WC 89 06 04) M Item 4.*Class, Rate,Other(WC 89 04 15) <br /> ❑ Insured's Mailing Address(WC 89 06 05) ❑ Interim Adjustment of Premium (WC 89 04 16) <br /> ❑ Experience Modification(WC 89 04 06) ❑ Carrier Servicing Office(WC 89 06 17) <br /> ❑ Producer's Name(WC 89 06 07) ❑ Interstate/Intrastate Risk ID Number(WC 89 06 18) <br /> ❑ Change in Workplace of Insured (WC 89 06 08) ❑ Carrier Number(WC 89 06 19) <br /> ❑ Insured's Legal Status(WC 89 06 10) ❑ Issuing Agency/Producer Office Address(WC 89 06 25) <br /> ❑ Item 3.A.States(WC 89 06 11) <br /> is changed to read: <br /> Specific Waiver of subrogation is added to the policy in favor of: City of Santa Ana, its City Council, officers, <br /> officials, employees, agents, and volunteers <br /> 20 Civic Center Plaza Santa Ana 92701 CA <br /> Class code 8742-0 <br /> Start Date: 2025-04-23 to End Date: 2025-09-14 <br /> Adding form(s): EndmtMailSheet WC890600B WC990001 E—Class WC990001 E PmtSched <br /> Page 10 of 10 GMJNWCEV <br />