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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 <br /> (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 <br /> enforce our right against the person or organization named in the Schedule. (This agreement applies only to <br /> the extent that 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 /> Schedule <br /> Any person or organization against whom you have agreed to <br /> waive your right of recovery in a written contract, provided <br /> such contract was executed prior to the date of loss. <br /> For policies or exposure in Missouri: <br /> Any person or organization for which the employer has agreed by written contract, executed prior to loss, <br /> may execute a waiver of subrogation. However, for purposes of work performed by the employer in <br /> Missouri, this waiver of subrogation does not apply to any construction group of classifications as <br /> designated by the waiver of right to recover from others (subrogation) rule in our manual. <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 03-01-25 Policy No. 71843940 Endorsement No. <br /> Insured CB GENERAL HOLDINGS, LLC Premium $ Incl. <br /> Insurance Company Federal Insurance Company <br /> Countersigned By <br /> WC 00 03 13 <br /> (Ed.4-84) <br /> 1983 Nationai Council on Compensation Insurance. <br /> Insured Copy APPROVED <br /> By Luisa Najera at 3:22 pm,Dec 12,2025 <br />