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ENDORSEMENT AGREEMENT <br /> STATE WAIVER OF SUBROGATION <br /> BLANKET BASIS 9348236-24 <br /> FUND RENEWAL <br /> SP <br /> HOME OFFICE 9-96-87--55 <br /> SAN FRANCISCO EFFECTIVE NOVEMBER 5, 2024 AT 12 . 01 A.M. PAGE 1 OF 1 <br /> AND EXPIRING NOVEMBER 5, 2025 AT 12 . 01 A.M. <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 /> COMMUNITY HEALTH INITIATIVE OF ORA <br /> 1505 E 17TH ST STE 10B <br /> SANTA ANA, CA 92705 <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 JOB DESCRIPTION <br /> ANY PERSON OR ORGANIZATION BLANKET WAIVER OF <br /> FOR WHOM THE NAMED INSURED SUBROGATION <br /> HAS AGREED BY WRITTEN <br /> CONTRACT TO FURNISH THIS <br /> WAIVER <br /> NOTHING IN THIS ENDORSEMENT SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND <br /> ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY <br /> OTHER THAN AS ABOVE STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE <br /> HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR <br /> LIMITATIONS IN THIS ENDORSEMENT. <br /> COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: NOVEMBER 7, 2024 <br /> 2572 AUTHORIZED REPRESENT NE PRESIDENT AND CEO <br /> SCIF FORM 10217 iREV.A-2018I DLL) 6P 217 <br />