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WORKERS' COMPENSATION AND EMPLOYERS' IJABILITY INSURANCE POLICY <br />WC 124 <br />(4-84) <br />WC 00 03 13 <br />WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT <br />This endorsement changes the poicy to which d is attached effective on the inception data of the policy unless a <br />different date is indicated below. <br />(rhe folbwirg "attaching clause' need he complated only when this ar4asement o issued subsequent to preparafon of ft policy.) <br />This endorsement, effective on 5/01/15 at 12:01 A. M. standard time, forms a part of <br />10.s`EI <br />Policy No. 7474-7&56 of the Chubb Indemnity Company <br />NAME OF INSURANCE COMPANY) <br />issued to Palermo TT Holdings, Inc. <br />Endorsement No. <br />AWMr¢ed RePresantaMe r <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 <br />extent that you perforin work under a wdtten contract that requires you to obtain this agreement from us.` <br />This agreement shall not operate directly or indirectly to benefit any one not named in the Schedule. <br />Schad le <br />WC 124,4-941 <br />WC 00 03 13 Copyright IW3 rretbnai Caund on CompensaWn Insurance Pails t of t <br />