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INSURED: All City Management Services, Inc. <br />POLICY #: WCC33441OA <br />POLICY PERIOD: 01/01/2025 TO 01/01/2026 <br />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. ('Phis 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(S) OR ORGANIZATION(S) WITH WHOM YOU HAVE AGREED <br />TO SUCH WAIVER, IN A VALID WRITTEN CONTRACT OR WRITTEN <br />AGREEMENT THAT HAS BEEN EXECUTED PRIOR TO A 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 Policy No. Endorsement No. <br />Insured Premium $ <br />Countersigned By <br />