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i <br />MOT ofAmsfiaa, Inc, POIIcy 30110 86712 A110ther <br />WORKERS COMPENSATION AND EMPLOYERS 1,11ASLITY INSURANCE PCN,ICY WC 00ca 79 <br />(Ed. 4.84) <br />WAIVER OF OUR RIGHT TO RECOVER FROM OTHFAS ENDORSEMENT <br />We have the right to recover our paymante tram anyone liable for an InJury oovered bythis Policy. We will not anforoe our <br />right agalhst the person or organization named In the Schedule, (This agreement applies only to the extant that you <br />perform work under a wrflan eontractthal requires you to obtain We agreement from us.) <br />This agreamant shall not operats'dlrecily or Inclrectly to banafll agvono not named In the Rohedula. <br />Hohodule <br />ANY PEI86ON OR 0WANIZATzon ON WHOSE BERiiix You ARE REQU.Tarn TO OBTAIN <br />THIN WAIVER Oy OAR RI /HT To RECOVER EWE rrNOM A WRITTEN CONTRACT <br />OR AGPIR ENT. <br />Thta oMloroamen4 ohango ®the poloy to wmMi it A aftaahad and 7a atfogthra an the dateleavad onlaes afherntse atorad <br />(Itte lnlarreaean (aloe"roqulmd only whenth'e eryror%amanl hl Mauodaunaaqu0n1 to Prapnrallon of ft poltoy l <br />Lndclorsont Elrooflva Palley No. 9alorsomont Noy <br />Insured prowum$ <br />Insunuwo oompmny <br />Counleralynedby <br />WC OE 09'15 <br />(Ed, 4.04) Cop/dehf tees N10nal Council on Oarnpenwon Insurance. <br />