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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY <br />TEXAS WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT <br />This endorsement applies only to the insurance provided by the policy because Texas 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, but this waiver applies only with <br />respect to bodily injury arising out of the operations described in the Schedule where you are required by a written <br />contract to obtain this waiver from us. <br />This endorsement shall not operate directly or indirectly to benefit anyone not named in the Schedule. <br />The premium for this endorsement is shown in the Schedule. <br />Schedule <br />1. O Specific Waiver <br />Name of person or organization <br />(X) Blanket Waiver <br />Any person or organization for whom the Named Insured has agreed by written contract to furnish this <br />Waiver. ALL PERSONS OR ORGANIZATIONS ON FILE WITH THE <br />INSURED <br />2. Operations: <br />3. Premium <br />The premium charge for this endorsement shall be 2.0 percent of the premium developed on payroll in <br />connection with work performed for the above person(s) or organization(s) arising out of the operations <br />described. <br />4. Advance Premium <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 09/01/2024 Policy No, 406-04-54-43-0006 Endorsement No. <br />insured E.J. WARD. INC. Premium $ <br />Insurance Company Atlantic Specialty Insurance Company <br />Countersigned By <br />WC 42 03 04B 06 14 E-INSURED Page 1 of 1 <br />