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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 <br />not enforce our right against the person or organization named in the Schedule. This agreement applies <br />only to the extent that you perform work under a written contract that requires you to obtain this <br />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 <br />Insurers, takes effect on the 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 00 03 13 (04-1984) <br />Policy No. 7034525413 (AOS) <br />7034525394 (CA) <br />Attachment Code: D568691 Certificate ID: 22338224 <br />Docusign Envelope ID: FC887B74-13D0-4575-BB1C-E4A9D8E29E85