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!NA,Workers Compensation And Employers Liability Insurance <br />Policy Endorsement <br />- ........... - <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. <br />Schedule <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 effective <br />date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy unless another <br />expiration date is shown below. <br />Form No: WC 00 03 13 (04.1984) policy No: WC 8038020120 <br />Endorsement Effective bate: Endorsement Expiration Date: Policy Effective Date: 04/01 /2026 <br />Page: 1 of 1 Policy Page: 1 of 1 <br />Underwriting Company: American Casualty Company of Reading, Pennsylvania, 151 N Franklin St, <br />Chicago, EL 60606 <br />Copy right 1983 Nationa L LOUnn L on Lompensation Insurance. <br />