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BLANKET WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT <br />This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different <br />date is indicated below. <br />(The following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy). <br />This endorsement, effective 12:01 AM 07/01/2016 <br />Issued to NORTHSTAR GROUP SERVICES, INC. <br />By NEW HAMPSHIRE INSURANCE COMPANY <br />forms a part of Policy No. WC 341-573-10 <br />We have a right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce <br />our right against any person or organization with whom you have a written contract that requires you to obtain this <br />agreement from us, as regards any work you perform for such person or organization. <br />The additional premium for this endorsement shall be 2 % of the total estimated workers compensation premium <br />for this policy. <br />WC 04 03 61 Countersigned by________________e..______...______ <br />(Ed. 11/90) <br />Authorized Representative <br />ft6 VEWE dt BY: EUMCE HE. RE DIA (PG Of <br />