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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 SQUARE <br />HARTFORD CT 06183 <br />UB-7Y810638-24-42-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: OF08-22-24 11 <br />Docusign Envelope ID: FDE0F9FD-AB56-490F-B27D-2843BB8D23A5