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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 <br />(Ed. 4-84) <br />WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT <br />We have the right to recover our payments from anyone liable for an Injury covered by this policy. We will not enforce <br />our right against the person or organization named In the Schedule. (This agreement applies only to the extent that you <br />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. <br />Schedule <br />ANY PERSON OR ORGANIZATION ON WHOSE BEHALF YOU ARE REQUIRED TO OBTAIN <br />THIS WAIVER OF OUR RIGHT TO RECOVER FROM UNDER A WRITTEN CONTRACT <br />OR AGREEMENT. NOT APPLICABLE IN KANSAS. <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 07/01/2016 PollcyNo. 3011086712 (all other�ndorsementNo. <br />Insured MGT of America Consulting, LLC Premium$ <br />Insurance Company Valley Forge Ins. Co. Countersigned by 4 <br />WC 00 03 13 <br />(Ed. 4-84) Copyright 1983 National Council on Compensation Insurance. <br />✓\P ' d 1"--4 E -7u i, C'c (r°6 17 ,-F 1 <br />