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llak <br />TRAVELERS/ J WORKERS COMPENSATION <br />AND <br />ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY <br />HARTFORD CT 06183 <br />ENDORSEMENT WC 00 03 13 (00) - 001 <br />POLICY NUMBER: UB-2Y352892-24-42-G <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 any one not named in the Schedule. <br />SCHEDULE <br />DESIGNATED PERSON: <br />DESIGNATED ORGANIZATION: <br />ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED <br />BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS <br />WAIVER. <br />RkkMVWgementDnisbn <br />REVIEWED&APPRO Br <br />® Risk Management SpedallsC <br />01 <br />DATE OF ISSUE: 04-19-24 ST ASSIGN: PAGE 1 OF <br />I3�)9'J C.L. T. UN-- .,- FL = i Jv292J - `z P, IPC'"I Eape T , <br />xtl, - ���fi,t- a�,.�i, ,emu -a-=., d, A_ .-i,at=,. <br />