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000wSWn Envelope ID: 000uu0o4-6uAo-40Co~^CoA-a1o18854o81A <br /> WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 <br /> (Ed. 4-84) <br /> WAIVER OF OUR RIGHT T0 RECOVER FROM OTHERS ENDORSEMENT <br /> We have the right to recover our payments from anyone liable for an injury covered by this policy. We will <br /> not enforce our right against the person or organization named in the Schedule, (This agreement opphno <br /> only to the extent that you perform work under a written contract that requires you to obtain this <br /> agreement from us.) <br /> This agreement shall not operate directly or indirectly tn benefit anyone not named in the Schedule. <br /> Schedule <br /> Any person or organization that you perform work for that is liable for an injury, covered by this policy, that <br /> prior to the injury has vvhtLnn contract requiring m waiver of our right to recover from them. <br /> moRzo CA8oLzmD <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 11/4/2014 Policy No. 5B20546 Endorsement No, I <br /> insured TILE RESTORATION, INC. premium* <br /> Insurance Company IMASCO INSURANCE COMPANY counoamignedby <br /> VVCO00313 <br /> (Ed. 4'84) Copyright 1g8u National Council onCompensation Insurance. <br />