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DocuSign Envelope ID:7ACADO9D-B318-4AD6-B8E5-CB7B9C2A289F <br /> WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 <br /> (Ed. 04-84) <br /> WAIVER OF OUR RIGHT TO 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 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 /> This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. <br /> Schedule <br /> ALL PERSONS AND/OR ORGANIZATIONS THAT ARE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT WITH THE INSURED, <br /> EXECUTED PRIOR TO THE ACCIDENT OR LOSS, THAT WAIVER OF SUBROGATION BE PROVIDED UNDER THIS POLICY FOR <br /> WORK PERFORMED BY YOU FOR THAT PERSON AND/OR ORGANIZATION <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: 04/01/2017 Endorsement No. <br /> Policy No. WC 0112779-02 <br /> Insured: Stearns, Conrad and Schmidt, Consulting Engineers, Inc. Premium$ <br /> Insurance Company: Zurich American Insurance Company <br /> WC124(4-84) Page 1 of 1 <br /> WC 00 03 13 Copyright 1983 National Council on Compensation Insurance, Inc. Uniform FormsTM <br />