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ENDORSEMENT WC 00 03 13 (00) - <br />POLICY NUMBER: <br />EMPLOYERS LIABILITY POLICY <br />AND <br />WORKERS COMPENSATION <br />WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT <br />001 <br />ONE TOWER SQUAREHARTFORD CT 06183 <br />UB-0K464798-21-42-G <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 any one not named in the Schedule. <br />SCHEDULE <br />DESIGNATED ORGANIZATION: <br />DESIGNATED PERSON: <br />ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED <br />BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS <br />WAIVER. <br />DATE OF ISSUE:PAGEST ASSIGN:OF12-10-20 1 1 <br />DocuSign Envelope ID: 15A54062-A0C2-4786-9B32-7A3F2AA86B05