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Workers' Compensation and Employers' Liability Policy <br />Named Insured <br />Endorsement Number <br />TYCO INTERNATIONAL MANAGEMENT COMPANY, LLC <br />9 ROSZEL ROAD <br />Policy Number <br />PRINCETON NJ 08540 <br />Symbol: WLR Number: C48018725 <br />Policy Period <br />Effective Date of Endorsement <br />10 -01 -2014 TO 10 -01 -2015 <br />10 -01 -2014 <br />Issued By (Name of Insurance Company) <br />INDEMNITY INSURANCE CO. OF NORTH AMERICA <br />Insert the olic number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the polic <br />TEXAS WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT <br />This endorsement applies only to the insurance provided by the policy because Texas is shown in item 3.A. of the Information <br />Page. <br />We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right <br />against the person or organization named in the Schedule, but this waiver applies only with respect to bodily injury arising out <br />of the operations described in the Schedule, where you are required by a written contract to obtain this waiver from us. <br />This endorsement shall not operate directly or indirectly to benefit anyone not named in the Schedule. <br />Schedule <br />Specific Waiver <br />Name of person or organization: <br />X ) Blanket Waiver <br />Any person or organization for whom the Named Insured has agreed by written contract to <br />furnish this waiver. <br />2. Operations: <br />3. Premium: <br />The premium charge for this endorsement shall be 2,0 percent of the premium developed on <br />payroll in connection with work performed for the above person(s) or organization(s) arising out of the <br />operations described. <br />4, Advance Premium: $0 <br />95�� <br />Autlwrized Agent <br />WC 420304A (1 /00) No. in U.S.A. <br />