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WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT <br />This endorsement changes the policy to which it is attached effective on inception date of the policy unless a different <br />date is indicated below. <br />(The following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy). <br />forms a part of Policy No. WC 015-89-3762This endorsement, effective 12:01 AM 04/01 /2020 <br />Issued to HOFFMAN & HOFFMAN, I NC. <br />By NEW HAMPSHIRE INSURANCE COMPANY <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 you <br />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 />ANY PERSON OR ORGANIZATION TO WHOM YOU BECOME OBLIGATED TO WAIVE YOUR RIGHTS OF RECOVERY AGAINST, UNDER ANY WRITTEN CONTRACT OR AGREEMENT YOU ENTER INTO PRIOR TO THE OCCURRENCE OF LOSS. <br />This form is not applicable in California, Kentucky, New Hampshire, New Jersey, North Dakota, Ohio, Texas, Utah, or <br />Washington. This form is not applicable in Missouri when there is a construction code on the policy and there is <br />Missouri premium or exposure. <br />WC 00 03 13 <br />(Ed. 04/84) Countersigned by ----------------------- <br />Authorized Representative <br />04/01/2023 <br />DocuSign Envelope ID: EF4B1761-E191-4214-9651-0FC3E17A972A