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I W AVELERgr <br />ONE TOMR. SQUARE <br />HARTFORD, CT 06159 <br />WORKERS COMPENSATION <br />AND <br />EMPLOYERS LIABILITY POLICY <br />ENDORSEMENT WC 000313(00)-01 <br />POLIGYNUMBER: tFJUH-117fiA22<0-173 <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 <br />enforce our right against the person or organization named in the Schedule, (This agreement applies only to the <br />extent that you perform work under a written, confixact 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 Schedula, <br />SCHEDULE <br />DESIGNATED PERSON: <br />DESIGNATED ORGANIZATION, <br />ANY PERSON OR 0904tt2ZATION FOR WHICH THE INSURED HAS AGREED <br />8Y WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS <br />WAIVER, <br />DATE OF ISSUE: 71112017 ST ASSIGN: <br />