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STATE Endorsement Agreement <br /> COMPENSATION <br /> INSURANCE Waiver of Subrogation <br /> FUND <br /> 9100741-2025 <br /> Home Office Renewal <br /> San Francisco NA <br /> All Effective Dates are 1-81-08-39 <br /> at 12:01 AM Pacific Page 1 of 1 <br /> Standard Time or the <br /> Time Indicated at Effective October 1, 2025 at 12:01 AM <br /> Pacific Standard Time and Expiring October 1, 2026 at 12:01 AM <br /> AASCSC <br /> 850 N BIRCH ST <br /> SANTA ANA, CA 92701-3405 <br /> Anything in this policy to the contrary notwithstanding, it is agreed that the State <br /> Compensation Insurance Fund waives any right of subrogation against, <br /> City of Santa Ana <br /> which might arise by reason of any payment under this policy in connection with work <br /> performed by, <br /> AASCSC <br /> It is further agreed that the insured shall maintain payroll records accurately segregating the <br /> remuneration of employees while engaged in work for the above employer. <br /> It is further agreed that premium on the earning of such employees shall be increased by <br /> 3.00%. <br /> Nothing in this endorsement shall be held to vary, alter,waive or extend any of the terms, conditions, <br /> agreements, or limitations of this policy other than as above stated.Nothing elsewhere in this policy shall <br /> be held to vary, alter,waive or limit the terms,conditions, agreements or limitations in this endorsement. <br /> Countersigned and Issued at San Francisco September 30,2025 <br /> 2570 Authorized Representative President and CEO SF—END <br /> Rev.2/2025 OLD DP 217 <br />