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BLANKET WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT <br />This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different <br />date is indicated below. <br />(The following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy) <br />This endorsement, effective 12:01 AM 04/01 /2019 forms a part of Policy No. 015-89-3765 <br />Issued to PSOMAS <br />By NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA. <br />We have a right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce <br />our right against any person or organization with whom you have a written contract that requires you to obtain this <br />agreement from us, as regards any work you perform for such person or organization. <br />The additional premium for this endorsement shall be 2. 00 % of the total estimated workers compensation premium for <br />this policy. <br />REVIEWED & APPROVEL, <br />By RISk MANAGEMENT DiviSiON <br />EP 19 2 1 <br />ocm <br />FRANCINE R. VILLAREAL <br />WC 04 03 61 Countersigned by _ �'✓�`� �.t --'— "` <br />(Ed. 11 /90) <br />Authorized Representative <br />