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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 <br />WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS <br />ENDORSEMENT -CALIFORNIA <br />We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not <br />enforce our right against the person or organization named in the Schedule. (This agreement applies only to the <br />extent that you perform work under a written contract that requires you to obtain this agreement from us.) <br />You must maintain payroll records accurately segregating the remuneration of your employees while engaged in <br />the work described in the Schedule. <br />The additional premium for this endorsement shall be 0 % of the California workers' compensation premium <br />otherwise due on such remuneration. <br />SCHEDULE <br />Person or Organization Job Description <br />WHERE A WAIVER OF OUR RIGHT TO RECOVER FROM <br />OTHERS IS REQUIRED BY WRITTEN CONTRACT, <br />SUCH ADDITIONAL ENTITIES SHALL BE <br />CONSIDERED AUTOMATICALLY SCHEDULED BY THE <br />COMPANY. <br />INDIVIDUALLY SCHEDULED WAIVERS SHALL NOT BE <br />CONSTRUED TO OVERRIDE NOR NEGATE THIS <br />BLANKET WAIVER. <br />This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. <br />(The information below is required only when this endorsement is issued subsequent to preparation of the policy.) <br />Endorsement Effective 10/01/2025 Policy No. LDS4047264 <br />Insured CHIPOTLE MEXICAN GRILL, INC. <br />Insurance Company Safety National Casualty Corporation <br />Countersigned By <br />WC 04 03 06 (04 84) <br />Endorsement No. <br />Premium $ Included <br />Page 1 of 1 <br />° 1998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved. <br />ATTY/AGR.2026.036/Chipotle Mexican Grill, Inc. (861 Middlefield Rd) (Page 22 of 28) <br />