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Docusign Envelope ID:C101DF94-8EEA-4210-A163-1FB71C9DF46C <br /> CNA", 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 /> Any person or organization for which the employer has agreed by written contract, executed prior to loss, may <br /> execute a waiver of subrogation. However, for purposes of work performed by the employer in Missouri, this <br /> waiver of subrogation does not apply to any construction group of classifications as designated by the waiver <br /> of right to recover from others (subrogation) rule in our manual. <br /> Schedule <br /> z <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 /> n <br /> P <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 /> N <br /> n <br /> V <br /> O <br /> O <br /> O <br /> N <br /> kD <br /> cc <br /> Q7 <br /> M <br /> C7 <br /> H <br /> 0 <br /> Yj <br /> r <br /> +o <br /> 0 <br /> Ln <br /> N <br /> 4 <br /> W <br /> O <br /> m <br /> Cr <br /> r-I <br /> c <br /> c <br /> c <br /> c <br /> Form No:WC 00 03 13 (04-1984) Policy No:WC 6 79684599 Policy <br /> Endorsement Effective Date: Endorsement Expiration Date: Effective Date: 1 Ill 512024 <br /> Endorsement No: 13; Page: 1 of 1 Policy Page: 295 of 478 <br /> Underwriting Company:American Casualty Company of Reading, Pennsylvania, 151 N Franklin St, <br /> Chicago, IL 60606 <br /> Copyright 1983 National Council on Compensation Insurance. <br />