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DocuSign Envelope ID:27028AA0-327E-4DEF-B3D5-A4F12D5863EC <br /> WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 <br /> (Ed. 4-84) <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 enforce <br /> our right against the person or organization named in the Schedule. (This agreement applies only to the extent that <br /> 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 /> 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 written contract requiring a waiver of our right to recover from them. <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 1/1/2020 Effective Policy No. WCV61 '7 Endorsement No. <br /> Insured Summit Design and Engineering Services PLLC remium/ <br /> Insurance Company Countersigned by <br /> Accident Fund Insurance Co of America <br /> WC 00 03 13 <br /> (Ed. 4-84) <br /> ®1983 National Council on Compensation Insurance. <br />