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Schedule <br />This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. <br />(The information below is required only when this endorsement is issued subsequent to preparation of the policy.) <br />Endorsement Effective Policy No. Endorsement No. <br />Insured Premium $ <br />Insurance Company Countersigned by <br />WC 00 03 13 <br />(Ed. 4-84)Copyright 1983 National Council on Compensation Insurance. <br />WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 <br />(Ed. 4-84) <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 />ANY PERSON OR ORGANIZATION WHEN REQUIRED BY WRITTEN CONTRACT <br />Docusign Envelope ID: 186E0FF8-664C-4A5C-9F97-28196CE69FD1Docusign Envelope ID: 01F429D6-252B-4D8E-984E-70B5432F90BA