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c Pw, Workers Compensation And Employers Liability Insurance NA <br /> Vlliicy Ilh.uiva .)�ui seui°ioieil°yin: <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. <br /> This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. <br /> Any person or organization for which the employer has agreed by written contract, executed prior to loss, may <br /> execute a waiver of subrogation. However, for purposes of work performed by the employer in Missouri, this <br /> waiver of subrogation does not apply to any construction group of classifications as designated by the waiver <br /> of right to recover from others (subrogation) rule in our manual. <br /> Schedule <br /> Any Person or Organization on whose behalf you are required to obtain this waiver of our right to recover <br /> from under a written contract or agreement. <br /> The premium charge for the endorsement is reflected in the Schedule of Operations. <br /> All other terms and conditions of the policy remain unchanged. <br /> This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers, <br /> takes effect on the Policy Effective Date of said policy at the hour stated in said policy, unless another <br /> effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy <br /> unless another expiration date is shown below. <br /> ..... ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ............ ........................ <br /> Form No: WC 00 03 13 (04-1984) Policy No:WC 7092031056 <br /> Endorsement Effective Date: Endorsement Expiration Date: Policy Effective Date: 05/17/2025 <br /> Endorsement No: 137; Page: 1 of 1 <br /> Underwriting Company: American Casualty Company of Reading, Pennsylvania, 151 N Franklin St, <br /> Chicago, IL 60606 <br /> Copyright 1983 National Council on Compensation Insurance. <br />