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Attachment Code: D587581 Master TD: 1491 108, Certificate ID: 17506716 <br />CNA <br />POLICY NO: 7014842824 <br />WORKERS COMPENSATION <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 <br />this policy. We will not enforce our right against the person or organization named in the <br />Schedule.(This agreement applies only to the extent that you perform work under a <br />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 <br />the Schedule. <br />Schedule <br />Any person or organization against whom you have agreed to waive such right of <br />recovery in a written contract or agreement. <br />The premium charge for the endorsement is reflected in the Schedule of Operations. <br />All other terms and conditions of the policy remain unchanged. <br />This endorsement, which forms a part of and is for attachment to the policy issued by <br />the designated Insurers, takes effect on the Policy Effective date of said policy at the <br />hour stated in said policy, unless another effective date (the Endorsement Effective <br />Date is shown below, and expires concurrently with said policy unless <br />another expiration date is shown below. <br />Form No: WC00 03 13 (04-1984) <br />Endorsement Effective Date: 5/1 /2021 <br />Policy: WC657040561 <br />�w cF 1uAnwagmedDMsiun <br />Jy/\'x REVIEWED & APPROVED BY.- <br />V"° <br />--� RFsk janagement Analyst <br />