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DocuSign Envelope ID: D88FA102-A4A5-4F89-BB27-3941CF5F6548 <br />Attachment Code: D574650 Certificate ID: 16765248 <br />WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY <br />WC 00 03 13 <br />WC0146330 Dudek 8/28/20228/28/2023 (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 YOU ARE REQUIRED TO WAIVE YOUR RIGHTS OF <br />RECOVERY IN A WRITTEN CONTRACT, AGREEMENT OR PERMIT WITH THE NAMED <br />INSURED. <br />WC 00 03 13 <br />�Ed. 4-84) <br />1983 Nation "nC8vi?ogensation Insurance. <br />16-72 <br />10/18/2022 <br />