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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 43 03 05 <br />POLICY NUMBER: WC 2540616-03 (Ed.7-00) <br />UTAH WAIVER OF SUBROGATION ENDORSEMENT <br />This endorsement applies only to the insurance provided by the policy because Utah is shown in Item 3.A. of the <br />Information Page. <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. Our waiver of <br />rights does not release your employees' rights against third parties and does not release our authority as trustee of <br />claims against third parties. <br />Schedule <br />ALL PERSONS AND/OR ORGANIZATIONS THAT ARE REQUIRED BY <br />WRITTEN CONTRACT OR AGREEMENT WITH THE INSURED, EXECUTED <br />PRIOR TO THE ACCIDENT OR LOSS, THAT WAIVER OF SUBROGATION <br />BE PROVIDED UNDER THIS POLICY FOR WORK PERFORMED BY YOU FOR <br />THAT PERSON AND/OR ORGANIZATION. <br />WC 43 03 05 <br />(Ed. 7-00) <br />(c) 2000 National Council on Compensation Insurance, Inc. <br />�w.^.►'n &A� B. <br />'+�Lr�J' %au l�resaaa <br />01 <br />�Rizk Ma,wgemmi Oenral Aitle <br />