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STATE ENDORSEMENT AGREEMENT BROKER COPY <br /> COMPENSATION WAIVER OF SUBROGATION <br /> INSURANCE BLANKET BASIS 9281163-21 <br /> FUND RENEWAL <br /> NF <br /> HOME OFFICE 5-87-80-58 <br /> SAN FRANCISCO EFFECTIVE AUGUST 1, 2021 AT 12.01 A.M. PAGE 1 OF 1 <br /> ALL EFFECTIVE DATES ARE AND EXPIRING AUGUST 1, 2022 AT 12.01 A.M. <br /> AT 12:01 AM PACIFIC <br /> STANDARD TIME OR THE <br /> TIME INDICATED AT <br /> PACIFIC STANDARD TIME <br /> PENECORE DRILLING <br /> 220 N EAST ST <br /> WOODLAND, CA 95776 <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 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: AUGUST 3 , 2021 <br /> 2572 <br /> AUTHORIZED REPRESENTIVE PRESIDENT AND CEO <br /> SCIF FORM 10217 MEV.7-2014) OLD OF 217 <br />