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Attachment Code: D587581 Master TD: 1491 108, Certificate ID: 17506716 <br />CNA <br />WORKERS COMPENSATION <br />TEXAS WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT <br />This endorsement applies only to the insurance provided by the policy because Texas is shown <br />in Item 3.A. of the Information Page. <br />We have the right to recover our payments from anyone liable for an injury covered by this <br />policy. We will not enforce our right against the person or organization named in the Schedule, <br />but this waiver applies only with respect to bodily injury arising out of the operations described in <br />the Schedule where you are required by a written contract to obtain this waiver from us. <br />This endorsement shall not operate directly or indirectly to benefit anyone not named in the <br />Schedule. <br />The premium for this endorsement is shown in the Schedule. <br />Schedule <br />1. [ ] Specific Waiver <br />[X] Blanket Waiver <br />Any person or organization for whom the Named Insured has agreed by written contract to <br />furnish this waiver. <br />2. Operations: Waiver of Subrogation Operations <br />Premium: <br />The premium charge for this endorsement shall be <br />premium developed on payroll in connection with work performed for the above person(s) or <br />organization(s) arising out of the operations described. <br />1. Advance Premium: Waiver of Subrogation Advance Premium <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 the <br />designated Insurers, takes effect on the Policy Effective date of said policy at the hour stated in <br />said policy, unless another effective date (the Endorsement Effective Date) is shown below, and <br />expires concurrently with said policy unless another expiration date is shown below. <br />Form No:WC.:42 03 04 B (06-2014) <br />Endorsement Effective Date:05/01 /2021 <br />Policy No. 7014842824 <br />cF RAManagementDMsian <br />Jy/\'x REVIEWED & APPROVED BY.- <br />V"° <br />--� Risk janagement Analyst <br />