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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 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 />Any person or organization where waiver of our right to recover is required by written contract with such person or <br />organization provided such contract was executed prior to the date of 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 01-01-2021 <br />Insured ALLIED UNIVERSAL TOPCO, LLC <br />Insurance Company <br />XL Insurance America, Inc. <br />WC 00 03 13 <br />(Ed. 4-84) <br />a> 1983 National Council on Lam pensation Insurance. <br />Policy No. RWD3001203-05 Endorsement No. <br />Countersigned by <br />Risk mougenwltwil[an <br />cREvle 6{{A�RRRo��'v//®Bra� +o <br />®' Yi <br />® Risk Management Malys[ u <br />