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TRAVELERS J? <br />WORKERS COMPENSATION <br />AND <br />EMPLOYERS LIABILITY POLICY <br />ENDORSEMENT WC 00 03 13 (00)-01 <br />POLICY NUMBER: (PJ-UB-8166N36-A-10) <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. (Phis 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 />o <br />o <br />m-? <br />o? <br />o? <br />o? <br />o? <br />m. <br />001362 <br />DESIGNATED PERSON: <br />DESIGNATED ORGANIZATION: <br />ANY PERSON OR ORGANIZATION FOR WHOM THE NAMED INSURED <br />HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS <br />TO FURNISH THIS WAIVER. <br />ApPROVED AS TO ?piZM <br />?'' supa >tat Sheedy <br />?y,;is?anti City Attorney <br />DATE OF ISSUE: 08-02-10 ST ASSIGN: