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PROOF OF INSURANCE (2024) CLOSED' a DATE (MM/DDIYYYY) C)R " CERTIFICATE OF LIABILITY INSURANCE 0,12312024 sn�l THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(es) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 1735 Technoto Drive, Suite 790 WC -467 5 Massey�(�cx Nam) PRODUCER PHONE 40. -------- ... San joy CAI9s Insurance Services CONTACT etronella.masse mars 408 467 5699 gy �� �xti 5 E-MAIL P y@ .com ADDRSs --- ...,.,. ....... Ahre SanJose-CerfReauestCaJmarsh-com I FAX 212-948�335 - """"�" ""'"'" "'""' '"""""'" i THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _ .......... ....... ........... _ _....._ IADDLSt)'rZ."" ..."POLICYNUMBER ILTR POLRCYEFF PLDID eXP "" ----...�.�� ......... LIMITS ........ I TYPE OF INSURANCE MMIDOPYYYY MM A X COMMERCIAL GENE� (ABILITY H22J 630-9P531464-TIL-23 12/0112023 12/01/2024 1 000,000 " CLAIMS -MADE X OCCUR.... E,S[occurracaJ h $._... ............ 1 000000 .... Global Extension MED EXP An one erson (Any p") $ Rost Liquor RSONAL & ADV INJURY 1,000,000 GEN'LAGGREGATE _. LIMIT APPLIES iPE GENERAL AGGREGATE $ 2,000,000 XPOLICY X LOC r PRDUCT-COMPIP OS O$ 2000 000PEo ti $ OTHER A AUTOMOBILE LIABILITY BA-5X90009A-23-13-G 12101/2023 12/01/2024 LIMIT COSII^&GLL, ...... $ 1,000,000 1 X ANY AUTO 'Comp/Coll. Deductible $1,000' _ BODILY INJURY (Per Person) BODILY � $ OWNED " SCHEDULED BODILY INJURY (Per accident) f $ AUTOS ONLY .... J AUTOS X 'HIRED X NON-OWNEDROPERTYLYAMAGE AUTOS ONLY ! r " r. iekurn,(J ,,, ,[ $ „" . "" ------- .. .. Is UMBRELLA LIAB OCCUR EACH OCCURRENCE $ _ EXCESS LIAR f AGGREGATE $ ........ ......... CLAIMS -MADE � � I $ RETE.. DED NTION $ A WORKERS COMPENSATION UB-9W16584-23-13-1-1 f2WQ023 12101/2024 X PER I f OTH AND EMPLOYERS' LIABILITY YIN L EACHACCIDENT ANYPROPRIETOR/PARTNER/EXECUTIVE �. N NIA OFFICER/MEMBEREXCLUDED? E.L. DISEASE EA EMIPLOYEE': $ 1,000,000 (Mandatory in NH) If describe under ` ��� �00 1,000,000 ;DESCRIPTION yes, OF OPERATIONS below R E"L DISEASE POLICY LIMIT $ B ` E801 Cyber Liability B0509FINPY2351411 12/0112/21 12101/2024 Limit 10,000,000 SIR $5,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) County of Ventura is included as additional insured (except workers' compensation) where required by written contract. Waiver of subrogation as required by written contract. TE HOLDER County of Ventura 800 S. Victoria Ave. Ventura. CA 93009 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE I zwg/ ,Brad & 1 W10c $e�tvlted ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: CN117631842 LOC #: San Jose AID AnnITMNAI RFMARKS SCHEDULE AGENCY NAMED INSURED Marsh Risk & Insurance Services Zoom Video Communications, Inc. �, _„___,_,_,_,,,_.................. 55 Almaden Blvd., Suite 6 POLICY NUMBER San Jose, CA 95113 CARRIER i.. NAIC CODE EFFECTIVE DATE: AUU1IJUNAL. KtMAKKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance GENERAL LIABILITY: Employee Benefits Effective 12/1/2023-12/1/2024 Travelers Paper. Travelers Property Casualty Company Of America Policy:H22J 630-9P531464-TIL-23 Limits: $,3,000,000 Each Claim $1,000,000 Aggregate Retro Active Date: 10/31/2016 CRIME Great American Insurance Company Policy No: SAA E789137 0100 Effective Date:12/01/2023 Expiration Date: 12/01/2025 Limit:$10,000,000 Occurrence/Aggregate Deductible: $100,000 Page 2 of 2 ACORD 101 (2008/01) (S) 2008 ACORD CORPOKAI ION. All rlgnts reservea. The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART GENERAL DESCRIPTION OF COVERAGE — This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to this Coverage Part. and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general coverage description only. Read all the provisions of this endorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. Non -Owned Watercraft — 75 Feet Long Or Less B. Who Is An Insured — Unnamed Subsidiaries C. Who Is An Insured — Employees — Supervisory Positions D. Who Is An Insured — Newly Acquired Or Formed Limited Liability Companies E. Who Is An Insured — Liability For Conduct Of Unnamed Partnerships Or Joint Ventures F. Blanket Additional Insured — Persons Or Organizations For Your Ongoing Operations As Required By Written Contract Or Agreement G. Blanket Additional Insured — Broad Form Vendors H. Blanket Additional Insured — Controlling Interest PROVISIONS I. Blanket Additional Insured — Mortgagees, Assignees, Successors Or Receivers J. Blanket Additional Insured —Governmental Entities — Permits Or Authorizations Relating To Premises II Blanket Additional Insured —Governmental Entities — Permits Or Authorizations Relating To Operations L. Medical Payments — Increased Limit M. Blanket Waiver Of Subrogation N. Contractual Liability —Railroads O. Damage To Premises Rented To You A. NON -OWNED WATERCRAFT — 75 FEET LONG OR LESS 1. The following replaces Paragraph (2) of Exclusion g., Aircraft. Auto Or Watercraft, in Paragraph 2. of SECTION I — COVERAGES — COVERAGE A — BODILY B. INJURY AND PROPERTY DAMAGE UABILITY: (2) A watercraft you do not own that is: (a) 75 feet long or less, and (b) Not being used to carry any person or property for a charge; 2. The following replaces Paragraph 2.e. of SECTION II — WHO IS AN INSURED: a. Any person or organization that with your express or implied consent, either uses or is responsible for the use of a watercraft that you do not own that is: (1) 75 feet long or less; and (2) Not being used to carry any person or property for a charge. WHO IS AN INSURED — UNNAMED SUBSIDIARIES The following is added to SECTION II — WHO IS AN INSURED: Any of your subsidiaries, other than a partnership or joint venture, that is not shown as a Named Insured in the Declarations is a Named Insured if: a. You are the sale owner of, or maintain an ownership interest of more than 50% in, such subsidiary on the first day of the policy period; and b. Such subsidiary is not an insured under similar other insurance. CG D417 0219 a 2017 The Travelers Indemnity Company. All rights resemd. Page 1 of 5 Includes copyrighted material of Insurance services Office, Inc. with Its permission. COMMERCIAL GENERAL LIABILITY No such subsidiary is an insured for "bodily injury" or "property damage" that occurred, or "personal and advertising injury' caused by an offense committed: a. Before you maintained an ownership interest of more than 50% in such subsidiary; or b. After the date, if any, during the policy period that you no longer maintain an ownership interest of more than 50% in such subsidiary. For purposes of Paragraph 1. or Section II — Who Is An Insured, each such subsidiary will be deemed to be designated in the Declarations as: a. A limited liability company; b. An organization other than a partnership, joint venture or limited liability company; or c. A trust; as indicated in its name or the documents that govern its structure. C. WHO 15 AN INSURED — EMPLOYEES — SUPERVISORY POSITIONS The following is added to Paragraph 2.a.(1) of SECTION II — WHO IS AN INSURED: Paragraphs (1)(a), (b) and (c) above do not apply to "bodily injury" to a co -"employee" while in the course of the co -"employee's" employment by you arising out of work by any of your "employees" who hold a supervisory position. D. WHO IS AN INSURED — NEWLY ACQUIRED OR FORMED LIMITED LIABILITY COMPANIES The following replaces Paragraph 3. of SECTION II —WHO IS AN INSURED: 3. Any organization you newly acquire or form, other than a partnership or joint venture, and of which you are the sole owner or in which you maintain an ownership interest of more than 50%, will qualify as a Named Insured if there is no other similar insurance available to that organization. However: a. Coverage under this provision is afforded only: (1) Until the 180th day after you acquire or form the organization or the end of the policy period, whichever is earlier, if you do not report such organization in writing to us within 180 days after you acquire or form it; or (2) Until the end of the policy period, when that date is later than 180 days after you acquire or form such organization, if you report such organization in writing, to us within 180 days after you acquire or form it; b. Coverage A does not apply to "bodily injury" or "property damage" that occurred before you acquired or formed the organization; and c. Coverage B does not apply to "personal and advertising injury' arising out of an offense committed before you acquired or formed the organization. For the purposes of Paragraph 1. of Section II — Who Is An Insured, each such organization will be deemed to be designated in the Declarations as: a. A limited liability company; b. An organization, other than a partnership, joint venture or limited liability company; or c. A trust; as indicated in its name or the documents that govern its structure. E. WHO IS AN INSURED — LIABILITY FOR CONDUCT OF UNNAMED PARTNERSHIPS OR JOINT VENTURES The following replaces the last paragraph of SECTION II — WHO IS AN INSURED: No person or organization is an insured with respect to the conduct of arty current or past partnership or joint venture that is not shown as a Named Insured in the Declarations. This paragraph does not apply to any such partnership or joint venture that otherwise qualifies as an insured under Section 11— Who Is An Insured. F. BLANKET ADDITIONAL INSURED — PERSONS OR ORGANIZATIONS FOR YOUR ONGOING OPERATIONS AS REQUIRED BY WRITTEN CONTRACT OR AGREEMENT The following is added to SECTION II — WHO IS AN INSURED: Any person or organization that is not otherwise an insured under this Coverage Part and that you have agreed in a written contract or agreement to include as an additional insured on this Coverage Part is an insured, but only with respect to liability for "bodily injury' or "property damage" that: a. Occurs subsequent to the signing of that contract or agreement; and b. Is caused, in whole or in part, by your acts or omissions in the performance of your ongoing operations to which that contract or Page 2 of 5 O 2017 The Travelers Indemnity Company. All rights reserved. CG D4 17 02 19 Includes copyrighted material of Insurance Services Office, Inc. with Its permission. agreement applies or the acts or omissions of any person or organization performing such operations on your behalf. The limits of insurance provided to such insured will be the minimum limits that you agreed to provide in the written contract or agreement, or the limits shown in the Declarations, whichever are less. G. BLANKET ADDITIONAL INSURED — BROAD FORM VENDORS The following is added to SECTION II — WHO IS AN INSURED: Any person or organization that is a vendor and that you have agreed in a written contract or agreement to include as an additional insured on this Coverage Part is an insured, but only with respect to liability for "bodily injury" or "property damage" that: a. Occurs subsequent to the signing of that contract or agreement; and b. Arises out of "your products" that are distributed or sold in the regular course of such vendors business. The insurance provided to such vendor is subject to the following provisions: a. The limits of insurance provided to such vendor will be the minimum limits that you agreed to provide in the written contract or agreement, or the limits shown in the Declarations, whichever are less. COMMERCIAL GENERAL LIABILITY performed at such vendor's premises in connection with the sale of "your products"; or (6) "Your products" that, after distribution or sale by you, have been labeled or relabeled or used as a container, part or ingredient of any other thing or substance by or on behalf of such vendor. Coverage under this provision does not apply to: a. Any person or organization from whom you have acquired "your products", or any ingredient, part or container entering into, accompanying or containing such products; or b. Any vendor for which coverage as an additional insured specifically is scheduled by endorsement. H. BLANKET ADDITIONAL INSURED — CONTROLLING INTEREST 1. The following is added to SECTION II —WHO IS AN INSURED: Any person or organization that has financial control of you is an insured with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" that arises out of: b. The insurance provided to such vendor does not apply to: (1) Any express warranty not authorized by you or any distribution or sale far a purpose not authorized by you; (2) Any change in "your products" made by such vendor, (3) Repackaging, unless unpacked solely for the purpose of inspection, demonstration, testing, or the substitution of parts under instructions from the manufacturer, and 1. then repackaged in the original container, (4) Any failure to make such inspections, adjustments, tests or servicing as vendors agree to perform or normally undertake to perform In the regular course of business, in connectio n with the distribution or sale of "yaur products"; (5) Demonstration, installation, servicing or repair operations, except such operations a. Such financial control; or b. Such person's or organization's ownership, maintenance or use of premises leased to or occupied by you. The insurance provided to such person or organization does not apply to structural alterations, new construction or demolition operations performed by or on behalf of such person or organization. 2. The following is added to Paragraph 4. of SECTION 11— WHO IS AN INSURED: This paragraph does not apply to any premises owner, manager or lessor that has financial control of you. BLANKET ADDITIONAL INSURED — MORTGAGEES, ASSIGNEES, SUCCESSORS OR RECEIVERS The following is added to SECTION II — WHO IS AN INSURED: Any person or organization that is a mortgagee. assignee, successor or receiver and that you have agreed in a written contract or agreement to include as an additional insured on this Coverage Part is an insured, but only with respect to its CG D4 17 02 19 O 2017 The Travelers Indemnity Company. Al rights reserved. Page 3 of 5 Includes copyrighted material of Insurance Services Office, Inc. with its peenlsslom COMMERCIAL GENERAL LIABILITY liability as mortgagee, assignee, successor or receiver for "bodily injury, "property damage" or "personal and advertising injury" that: a. Is "bodily injury' or "property damage" that occurs, or is "'personal and advertising injury" caused by an offense that is committed, subsequent to the signing of that contract or agreement; and b. Arises out of the ownership, maintenance or use of the premises for which that mortgagee, assignee, successor or receiver is required under that contract or agreement to be included as an additional insured on this Coverage Part. The insurance provided to such mortgagee, assignee, successor or receiver is subject to the following provisions: a. The limits of insurance provided to such mortgagee, assignee, successor or receiver will be the minimum limits that you agreed to provide in the written contract or agreement. or the limits shown in the Declarations, whichever are less. b. The insurance provided to such person or organization does not apply to: (1) Any "bodily injury' or "property damage" that occurs, or any "personal and advertising injury' caused by an offense that is committed, after such contract or agreement is no longer in effect; or (2) Any "bodily injury, "property damage" or "personal and advertising injury arising out of any structural alterations, new construction or demolition operations performed by or on behalf of such mortgagee, assignee, successor or receiver. J. BLANKET ADDITIONAL INSURED — GOVERNMENTAL ENTITIES — PERMITS OR AUTHORIZATIONS RELATING TO PREMISES The following is added to SECTION II — WHO IS AN INSURED: Any governmental entity that has issued a permit or authorization with respect to premises owned or occupied by, or rented or loaned to, you and that you are required by any ordinance, law, building code or written contract or agreement to include as an additional insured on this Coverage Part is an insured, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury' arising out of the existence, ownership, use, maintenance, repair, construction, erection or removal of any of the following for which that governmental entity has issued such permit or authorization: advertising signs, awnings, canopies. cellar entrances, coal holes. driveways, manholes, marquees, hoist away openings, sidewalk vaults, elevators, street banners or decorations. K. BLANKET ADDITIONAL INSURED — GOVERNMENTAL ENTITIES — PERMITS OR AUTHORIZATIONS RELATING TO OPER- ATIONS The following is added to SECTION II — WHO IS AN INSURED: Any governmental entity that has issued apermit or authorization with respect to operations performed by you or on your behalf and that you are required by any ordnance, law, building code or written contract or agreement to include as an additional insured on this Coverage Part is an insured, but only with respect to liability for "bodily injury', "property damage" or "personal and advertising injury' arising out of such operations. The insurance provided to such governmental entity does not apply to: a. Any "bodily injury, "property damage" or "personal and advertising injury" arising out of operations performed for the governmental entity; or b. Any "bodily injury" or "property damage" included in the "products -completed operations hazard". L. MEDICAL PAYMENTS— INCREASED LIMIT The following replaces Paragraph 7. of SECTION III — LIMITS OF INSURANCE: 7. Subject to Paragraph S. above, the Medical Expense Limit is the most we will pay under Coverage C for all medical expenses because of "bodily injury" sustained by any one person, and will be the higher of: a. $10,000; or b. The amount shown in the Declarations of this Coverage Part for Medical Expense Limit. M. BLANKET WAIVER OF SUBROGATION The following is added to Paragraph B., Transfer Of (Rights Of Recovery Against Others To Us. of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: If the insured has agreed in a contract or agreement to waive that insured's right of recovery against any person or organization, we Page 4 of 5 O 2017 The TYawlem Indemnity Company. All rights reserved. CG D417 0219 Includes copyrighted material of Insurance SenAces Office, Inc. with Its permission. waive our right of recovery against such person or organization. but only for payments we make because of a. "Bodily injury" or "property damage" that occurs; or b. "Personal and advertising injury" caused by an dfiense that is committed; subsequent to the execution of the contract or agreement N. CONTRACTUAL LIABILITY — RAILROADS 1. The following replaces Paragraph c. of the definition of *insured contrail" in the DEFIMTIONS Section: c. Any easement or license agreement; COMMERCIAL GENERAL LIABILITY 2. Paragraph f.(1) of the definition of "insured contract° in the DEFINITIONS Section is deleted. O. DAMAGE TO PREMISES RENTED TO YOU The following replaces the definition of "premises damage" in the DEFINITIONS Section: "Premises damage" means "property damage" to: a. Any premises while rented to you or temporarily occupied by you with permission of the owner, or b. The contents of any premises while such premises is rented to you, if you rent such premises for a period of seven or fewer consecutive days. CG D4 17 02 19 0 2017 The Travelers Indemnity Company. All rights reserved. Page 5 of 5 Includes copyrighted material of Insurance Services afBce. Inc. with Its permission. COMMERCIAL GENERAL LIABILITY c. Method Of Sharing If all of the other insurance permits contribution by equal shares. we will follow this method also. Under this approach each insurer contributes equal amounts until it has paid its applicable limit of insurance or none of the loss remains, whichever comes first. If any of the other insurance does not permit contribution by equal sham, we will contribute by limits. Under this method, each insurers share is based on the ratio of its applicable limit of insurance to the total applicable limits of insurance of all insurers. d. Primary And Non -Contributory Insurance If Required By Written Contract If you specifically agree in a written contract or agreement that the insurance afforded to an insured under this Coverage Part must apply on a primary basis, or a primary and non- contributory basis, this insurance is primary to other insurance that is available to such insured which covers such insured as a named insured, and we will not share with that other insurance, provided that (1) The "bodily injury' or "property damage" for which coverage is sought occurs; and (2) The "personal and advertising injury' for which coverage is sought is caused by an offense that is committed; subsequent to the signing of that contract or agreement by you- S. Premium Audit a. We will compute all premiums for this Coverage Part in accordance with our rules and rates. b. Premium shown in this Coverage Part as advance premium is a deposit premium only. At the close of each audit period we will compute the earned premium for that period and send notice to the first Named Insured. The due date for audit and retrospective premiums is the date shown as the due date on the bill. If the sum of the advance and audit premiums paid for the policy period is greater than the eared premium, we will return the excess to the first Named Insured. c. The first Named Insured must keep records of the information we need for premium computation, and send us copies at such times as we may request 6. Representations By accepting this policy. you agree; a. The statements In the Declarations are accurate and complete; b. Those statements are based upon representations you made to us; and c. We have issued this policy in reliance upon your representations. The unintentional omission of, or unintentional error in, any information provided by you which we relied upon in issuing this policy will not prejudice your rights under this insurance. However, this provision does not affect our right to collect additional premium or to exercise our rights of cancellation or nonrenewal in accordance with applicable insurance laws or regulations. 7. Separation Of Insureds Except with respect to the Limits of Insurance, and any rights or duties specifically assigned in this Coverage Part to the first Named Insured, this insurance applies: a. As if each Named Insured were the only Named Insured; and b. Separately to each insured against whom claim is made or 0suir is brought 0. Transfer Of Rights Of Recovery Against Others To Us If the insured has rights to recover all or part of any payment we have made under this Coverage Part, those rights are transferred to us. The insured must do nothing after loss to impair them. At our request, the insured will bring "suit" or transfer those rights to us and help us enforce them. 9. When We Do Not Renew If we decide not to renew this Coverage Part, we will mail or deliver to the first Named Insured shown in the Declarations written notice of the nonrenewal not less than 30 days before the expiration date - If notice is mailed, prof of mailing will be sufficient proof of notice. SECTION V — DEFINITIONS 1. "Advertisemenr means a notice that is broadcast or published to the general public or specific market segments about your goods, products or services for the purpose of attracting customers or supporters. For the purposes of this definition: a. Notices that are published include material placed on the Internet or on similar electronic means of communication; and b. Regarding websites, only that part of a website that is about your goods, products or services for the purposes of attracting customers or supporters is considered an advertisement. Page 16 of 21 m 2017 The Travelers Indemnity Company. All rights reserved CG T1 00 0219 Includes copyrighted materW of Insurance Services Office, Inc. with Its peenlsslon. ll WORKERS COMPENSATION TRAVELERS AND ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY HARTFORD CT 06183 ENDORSEMENT WC 99 03 76 ( A) - 001 POLICYNUMBER: UB-9WI61584-23-I3-8 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA (BLANKET WAIVER) We have the right to recover our payments from anyone liable for an Injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. The additional premium for this endorsement shall be 2.00 % of the California workers' compensation pre- mium. Schedule Person or Organization Job Description ANY PERSON OR ORGANIZATION FOR WHICH THE rNSURZo HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO Loss TO BURNISH THIS WAMR. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective Policy No. Endorsement No. Insured Premium Insurance Company Countersigned by DATE OF ISSUE: 12-20-23 ST ASSIGN: Page 1 of 1