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Workers Compensation And Employers Liability Insurance <br />Policy Endorsement <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 />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 />All other terms and conditions of the policy remain unchanged. <br />This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers, <br />takes effect on the Policy Effective Date of said policy at the hour stated in said policy, unless another <br />effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy <br />unless another expiration date is shown below. <br />WC 7 18235090 <br />Endorsement No: 4; Page: 1 of 1 Policy Page: 52 of 62 <br />Underwriting Company: National Fire Insurance Company of Hartford, 151 N Franklin St, Chicago, IL <br />60606 <br />Form No: WC 00 03 13 (04-1984) <br />Endorsement Effective Date: <br />Policy No: <br />Policy Effective Date: 03/01/2023Endorsement Expiration Date: <br />Copyright 1983 National Council on Compensation Insurance. <br />DocuSign Envelope ID: 797C32F6-C1CE-44EB-BF17-813A5939396C