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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY <br />WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT <br />WC 00 03 13 <br />(Ed. 4-84) <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 applies only <br />to the extent that you perform work under a written contract that requires you to obtain this agreement from <br />us.) <br />This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. <br />Schedule <br />* Blanket Waiver of Subrogation Applies* <br />This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. <br /> <br />Carrier: Bridgefield Casualty Insurance Company <br />Effective Date of Endorsement: January 1 , 2023 <br />Policy Number: 0196-56884 <br />Insured: Summit Design and Engineering Services <br />WC 00 03 13 (Ed. 4-84) <br />"Includes copyright material of the National Council on Compensation Insurance, Inc. used with its permission. Copyright 1984 NCCI" <br />DocuSign Envelope ID: 42CE1DAC-C809-4104-BD18-FA7A68891DDA