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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICYWC 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 not enforce <br />our right against the person or organization named in the Schedule. (This agreement applies only to the extent that <br />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 />Schedule <br />Where required by written agreement signed prior to loss. <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 />RWD3000955-10Included <br />InsuredPremium <br />Falck USA, Inc. <br />Insurance CompanyCountersigned by___________________________________________ <br />XL Insurance America, Inc. <br />WC 00 03 13 <br />(Ed. 4-84) <br /> 1983 National Council on Compensation Insurance. <br /> <br />