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11 /6/2024 <br />WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 0313 <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 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 />Name: Any person or organization from whom you are required to waive your right to recover <br />under a written contract or agreement in effect prior to any loss or damage <br />Address: <br />Description of Waiver: Any person or organization from whom you are required to waive your right to recover <br />under a written contract or agreement in effect prior to any loss or damage <br />JoblD: <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 11/01/2024 11/01/2025 <br />Insured Allison Mechanical, Inc. <br />Insurance Company <br />WC 00 03 13 <br />(Ed. 4-84) <br />©1983 National Council on Compensation Insurance. <br />Policy No. A0114876-008 Endorsement No. <br />Premium <br />Countersigned by <br />Page 1 of 1 <br />APPROVED <br />By Cynthia Mora at 9:20 am, Nov 13, 2024 <br />82630159 ALLISMEC 12024-25 GLI, CAU, WCO, IC [primary] I Jennifer Bernal 111/6/2024 :49: n2 a ll %�f ll <br />This certificate cancels and supersedes ALL previously issued certificates. <br />