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Robert D. Niehaus,Inc <br /> WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY <br /> WAIVER OF OUR RIGHT TO RECOVER FROM <br /> OTHERS ENDORSEMENT <br /> This endorsement modifies insurance provided under the following: <br /> POLICY NUMBER:UB-OX750517-23-42-G <br /> EFFECTIVE DATE: 09/01/2023 <br /> INSURER: Travelers Property Casualty Co <br /> NAMED INSURED Robert D.Niehaus,Inc <br /> We have the right to recover our payments from anyone liable for an injury covered by this policy. We <br /> will not enforce our right against the person or organization named in the Schedule. This agreement <br /> applies only to the extent that you perform work under a written contract that requires you to obtain this <br /> agreement from us. <br /> This agreement shall not operate directly or indirectly to benefit any one not named in the Schedule. <br /> Schedule <br /> Blanket Waiver of Subrogation <br /> APPROVED <br /> By Cynthia Mora at 1:41 pm, Dec 05, 2024 <br /> This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise <br /> stated. <br /> © 1983 National Council on Compensation Insurance. WC 00 03 13 (4-84) <br />