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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: SCF Number: C48018749 <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 />ACE AMERICAN INSURANCE COMPANY <br />Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the 2reparation of the policy. <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 />ANY PERSON OR ORGANIZATION AGAINST WHOM YOU HAVE AGREED TO WAIVE YOUR RIGHT OF RECOVERY IN A WRITTEN <br />CONTRACT, PROVIDED SUCH CONTRACT WAS EXECUTED PRIOR TO THE DATE OF LOSS. <br />For the states of CA, UT, TX, refer to state specific endorsements. <br />This endorsement is not applicable in KY, NH, and NJ. <br />C _c <br />Authorized Agent <br />WC 00 03 13 (11/05) Copyright 1982 -83, National Council on Compensation <br />