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34 <br /> W rkers'Com ensation and Em loyers' Liability Policy <br /> Nam d Insured Endorsem nt Num er <br /> VCO PARENT, LLC <br /> 5501 VIRG NIA W Y Policy Num er <br /> SUITE 120 Sym ol: RW Num er: (25)7183-47-94 <br /> Policy Period Effective Date of Endorsem nt <br /> 09-15-2024 TO 09-15-2025 09-15-2024 <br /> Issued By(Nam of Insurance Com any) <br /> ACE AM RICAN INSURANCE CO ANY <br /> Insert the policy num er.The rem inder of the inform tion is to be com leted only when this endorsem nt is issued subsequent to the preparation of the policy. <br /> This endorsem nt changes the policy to which it is attached and is effective on the date issued unless otherwise stated. <br /> W IVER O O R RIG T TO RECO ER FRO HERS ENDO SEM NT <br /> W ave het ight to econer ur aym nts rom nyone iablb or fn njury overed y bs olicy. W ill not <br /> enfolrcb ur @ht against the erson r rganization arh d he chedule. This greem nt applies my o he <br /> extent that you perform work under a written contract that requires you to obtain this agreem nt from us. <br /> This agreem nt shall not operate directly or indirectly to benefit any one not nam d in the Schedule. <br /> Schedule <br /> ANY PERSON OR ORGANIZATION AGAINST WHOM YOU HAVE AGREED TO WAIVE YOUR <br /> RIGHT OF RECOVERY IN A WRITTEN CONTRACT, PROVIDED SUCH CONTRACT WAS <br /> EXECUTED PRIOR TO THE DATE OF LOSS . <br /> For the states of CA, UT, TX, refer to state specific endorsem nts. <br /> This endorsement is not applicable in KY, NH, and NJ. <br /> The ndorsem nt does of apply o olicies in ssouri where he m loyer is in he onstruction roup f code <br /> classifications. According o ection 87.150(6) of the ssouri statutes, a ontractual provision urporting o aive <br /> subrogation ights gainst public olicy nd oid here ne arty o he ontract is n m loyer in he construction <br /> group of code classifications. <br /> For Kansas, use f this ndorsem nt is im ted y he ansas airness n rivate onstruction ontract Act(K.S.A.. <br /> 16-1801 hrough 6-1807 nd ny m ndm nts hereto) and he ansas airness n ublic onstruction ontract <br /> Act(K.S.A 6-1901 hrough 6-1908 nd ny m ndm nts hereto). According o he cts rovision in ontract <br /> W for s rivate r utalic onstruction urporting o aive ubrbgation ights or osses r laim overed r aid y <br /> liability r orkers om ensation nsurancei hall be gairmt public olicy nd hall dDe oid v nd anenforceable <br /> except hat, ubject o he cts, ontract o y equjne aivEff f ubrogation or osses r laims t aid y <br /> consolidated or wrap-up insurance program <br /> Authorized Agent <br /> W 0 03 13(11/05) ©Copyright 1983-2017 National Council on Com ensation Insurance, Inc.All Rights Reserved. <br />