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ENDORSEMENT AGREEMENT <br />WAIVER OF SUBROGATION <br />HOME OFFICE <br />SAN FRANCISCO <br />BROKER COPY <br />REP D8 <br />9009868-16 <br />RENEWAL <br />NA <br />0-66-51-19 <br />PAGE 2 OF 2 <br />ALL EFFECTIVE DATES ARE <br />AT 12:01 AM PACIFIC EFFECTIVE JUNE 3, 2016 AT 12.01 A.M. <br />STANDARD TIME OR THE r <br />TIME INDICATED AT AND EXPIRING APRIL 9 2017 AT 12.01 A.M. <br />PACIFIC STANDARD TIME <br />4LEAF, INC. <br />2110 RHEEM DR STE A <br />PLEASANTON, CA 94588 <br />ANYTHING IN THIS POLICY TO THE CONTRARY NOTWITHSTANDING, <br />IT IS AGREED THAT THE STATE COMPENSATION INSURANCE FUND <br />WAIVES ANY RIGHT OF SUBROGATION AGAINST, <br />SAN LEANDRO DIV OF BLDG & SFTY SVCS <br />WHICH MIGHT ARISE BY REASON OF ANY PAYMENT UNDER THIS <br />POLICY IN CONNECTION WITH WORK PERFORMED BY, <br />4LEAF, INC. <br />IT IS FURTHER AGREED THAT THE INSURED SHALL MAINTAIN <br />PAYROLL RECORDS ACCURATELY SEGREGATING THE REMUNERATION <br />OF EMPLOYEES WHILE ENGAGED IN WORK FOR THE ABOVE <br />EMPLOYER. <br />IT IS FURTHER AGREED THAT PREMIUM ON THE EARNINGS OF SUCH <br />EMPLOYEES SHALL BE INCREASED BY 03%. <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: JUNE 7,2016 <br />AUTHORIZED REPRESENT IE PRESIDENT AND CEO <br />SCIF FORM 10217 (REV.7-2014) <br />2570 <br />OLD DP 217 <br />