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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 <br />(Ed. 04-84) <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 <br />you 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 />Any person or organization as required by written contract <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 6/9/2021 Policy No. SWC1342257 <br />Insured Inter -Pacific, Inc <br />Insurance Company Security National Insurance Company <br />Endorsement No. 0 <br />Premium $ 21,239 <br />Countersigned by Rbli MmgemmtUitislon <br />Ww9,t- <br />REVI <br />EWED&APPRov®6Y:WC 00 03 13Risk Management Analyst <br />