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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 <br /> (Ed. 4-84) <br /> POLICY NUMBER: 4 4 WC I 0 5 01918 <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 <br /> the 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 /> Schedule <br /> ANY PERSON OR ORGANIZATION WHERE WAIVER OF OUR RIGHT TO <br /> RECOVER IS PERMITTED BY LAW AND IS REQUIRED BY WRITTEN <br /> CONTRACT PROVIDED SUCH CONTRACT WAS EXECUTED PRIOR TO DATE <br /> OF LOSS <br /> For policies or exposure in Missouri: <br /> Any person or organization for which the employer has agreed by written contract, executed prior to loss, <br /> may execute a waiver of subrogation. However, for purposes of work performed by the employer in Missouri, <br /> this waiver of subrogation does not apply to any construction group of classifications as designated by the <br /> waiver of right to recover from others (subrogation) rule in our manual. <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 10/01/2025 Policy No. 44WC10501918 Endorsement No. <br /> Insured ARTHUR J. GALLAGHER & CO. Premium INCL. <br /> Insurance Company ARCH INDEMNITY INSURANCE COMPANY <br /> DATE OF ISSUE: 10-08-25 Countersigned By <br /> WC 00 03 13 <br /> (Ed. 4-84) <br /> ©1983 National Council on Compensation Insurance. <br />