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Awl <br />TRAVELERSJ <br />ONE TOWER SQUARE <br />HARTFORD, CT 06183 <br />WORKERS COMPENSATION <br />AND <br />EMPLOYERS LIABILITY POLICY <br />ENDORSEMENT WC 00 03 13 (00)- 01 <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 any one not named in the Schedule. <br />SCHEDULE <br />DESIGNATED PERSON: <br />914.1 It] � F—A 9 4 9X*J :keyll � I rIf—A I IM90 <br />M11 PERSOLI OR ORGAi%IZATIOLI FOR 'AAICA TAE IASIRED ihS <br />AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO <br />FURNISH THIS WAIVER. <br />ST ASSIGN: <br />Page 16 of 16 3MNY3QS5 <br />