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POLICY NUMBER: WCA204889510 <br /> WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY <br /> WC 00 03 13 04 84 <br /> WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS <br /> 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 the <br /> 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 as required in writing by contract or agreement prior to loss. <br /> Any person or organization for which the employer has agreed by written contract, executed prior to loss, may <br /> execute a waiver of subrogation. However, for purposes of work performed by the employer in Missouri, this waiver <br /> of subrogation does not apply to any construction group of classifications as designated by the waiver of right to <br /> recover from others (subrogation) rule in our manual. <br /> WC 00 03 13 04 84 © 1983 National Council on Compensation Insurance Page 1 of 1 <br />