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Attachment Code : D639681 Master ID: 1533719, Certificate ID:20838512 CNA Workers Compensation And Employers Liability Insurance Policy Endorsement WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us. This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Any person or organization for which the employer has agreed by written contract, executed prior to loss, may execute a waiver of subrogation. However, for purposes of work performed by the employer in Missouri, this waiver of subrogation does not apply to any construction group of classifications as designated by the waiver of right to recover from others(subrogation) rule in our manual. Schedule Any Person or Organization on whose behalf you are required to obtain this waiver of our right to recover from under a written contract or agreement. The premium charge for the endorsement is reflected in the Schedule of Operations. All other terms and conditions of the policy remain unchanged. This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers, takes effect on the Policy Effective Date of said policy at the hour stated in said policy, unless another effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy unless another expiration date is shown below. \ / Risk Marag eritntvision Form No:WC 00 03 13(04-1984) _� REVI�D&APPRav®By: Endorsement Effective Date: Endorsement Expiration Date: 9NrttINri A41+=A.wreto Endorsement No: 12; Page: 1 of 1 .811 `11Risk Management Specialist Underwriting Company: American Casualty Company of Reading, Pennsylvania, 151 N Franklin St, / \ Chicago,IL 60606 Copyright 1983 National Council on Compensation Insurance.