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TRAVELERS I' WORKERS COMPENSATION <br /> AND <br /> ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY <br /> HARTFORD CT 06183 ENDORSEMENT WC 43 03 05 (00) - 001 <br /> POLICY NUMBER: UBOX1376922551K <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 <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. Our waiver of <br /> rights does not release your employees' rights against third parties and does not release our authority as trustee <br /> of claims against third parties. <br /> Schedule <br /> Designated Person: <br /> Designated Organization: <br /> ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED <br /> BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS <br /> WAIVER. <br /> ST ASSIGN: PAGE 1 OF 1 <br />