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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 <br />(Ed.04-84) <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 <br />enforce our right against the person or organization named in the Schedule. (This agreement applies only to the <br />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(s) or organization(s) whom you are required by written contract. <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 11/13/20 Policy No. WC 0217111-05 <br />Insured <br />Insurance Company <br />Countersigned by <br />Endorsement No. <br />Premium $ <br />re^�••� Risk ManrgmientDNlelun <br />RwEwED APPRovm Br: <br />WC124 (4-84) <br />INTERNIW1258M Y13 Copyright 1983 National Council on Compensation Insurance, Inc. Risk Management nnaiyst <br />