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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 43 03 05 <br /> (Ed. 7-00) <br /> UTAH WAIVER OF SUBROGATION ENDORSEMENT <br /> This endorsement applies only to the insurance provided by the policy because Utah is shown in Item 3.A. of <br /> the 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. (This agreement applies only to the extent <br /> 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. Our waiver of <br /> rights does not release your employees' rights against third parties and does not release our authority as trustee of <br /> claims against third parties. <br /> Schedule <br /> Blanket Waiver <br /> Person/Organization: Blanket Waiver-Any person or organization for whom the Named <br /> Insured has agreed by written contract to furnish this waiver. <br /> Job Description Waiver Premium <br /> All UT Operations <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: 04/01/2026 Policy No.: LNWC728591 Endorsement No.: <br /> Insured: L.N. CURTIS&SONS, INC. Premium $ <br /> Insurance Company: Berkshire Hathaway Homestate Ins Co <br /> WC 43 03 05 Countersigned by <br /> (Ed. 7-00) <br /> ©2000 National Council on Compensation Insurance,Inc. <br />