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TEXAS WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY MANUAL WC 42 03 04 A <br />1st Reprint Effective January 1, 2000 <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 <br />written 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. ( ) 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 <br />this waiver. <br />2. Operations: <br />3. Premium <br />The premium charge for this endorsement shall be 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 />Notes: <br />Policy Number: SLICWC110660601 <br />Effective Cate: 04101/2025 <br />Insured Name: 02X Human Performance <br />Service Lloyds insurance Co. NAIC #43389 <br />