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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 INS, CO. OF NORTH AMERICA <br />Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. <br />UTAH WAIVER OF SUBROGATION ENDORSEMENT <br />This endorsement applies only to the insurance provided by the policy because Utah 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. (This agreement applies only to the extent that you perform work <br />under a written contract that requires you to obtain this agreement from u s.) <br />This agreement shall not operate directly or indirectly to benefit anyone not named in the schedule. Our waiver of rights does <br />not release your employees' rights against third parties and does not release our authority as trustee of claims against third <br />parties. <br />Schedule <br />ANY PERSON OR ORGANIZATION AGAINST WHOM YOU HAVE AGREED TO WAIVE <br />YOUR RIGHT OF RECOVERY IN A CONTRACT, PROVIDED SUCH CONTRACT WAS <br />EXECUTED PRIOR TO THE DATE OF LOSS. <br />Au9rorized Agent <br />WC 43 03 05 (10 /00) Ptd. in U.S.A. <br />