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DocuSign Envelope ID: E67DC299-98E1-4682-B281-3085AC9FC5B4 <br /> Workers Compensation And Employers Liability Insurance <br /> CNA . Policy Endorsement <br /> 0 <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 /> Any person or organization for which the employer has agreed by written contract, executed prior to loss, may <br /> execute a waiver of subrogation. However, for purposes of work performed by the employer in Missouri, this <br /> waiver of subrogation does not apply to any construction group of classifications as designated by the waiver <br /> of right to recover from others (subrogation) rule in our manual. <br /> cc <br /> W <br /> Schedule <br /> y <br /> 2 <br /> Any Person or Organization on whose behalf you are required to obtain this waiver of our right to recover <br /> from under a written contract or agreement. <br /> The premium charge for the endorsement is reflected in the Schedule of Operations. <br /> 0 <br /> All other terms and conditions of the policy remain unchanged, <br /> a <br /> m <br /> g !This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers,'' <br /> r takes effect on the Policy Effective Date of said policy at the hour stated in said policy, unless another <br /> E effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy j <br /> unless another expiration date is shown below. <br /> a <br /> 0 <br /> 0 <br /> i <br /> � 1 <br /> �r <br /> Form No:WC 00 03 13 (04-1984) Policy No:6079684599 <br /> Endorsement Effective Date 11/15/2021 Endorsement Expiration Date: 11/15/2022 Policy Effective Date: 11/15/2021 <br /> Endorsement No:3; Page: 1 of 1 Policy Page: 191 of 318 <br /> Underwriting Company:The Continental Insurance Company, 151 N Franklin St, Chicago, IL 60606 <br /> Copyright 1983 National Council on Compensation insurance. <br />