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This endorsement changes the policy to which it Is attached effective on the inception, date of the policy unless a different <br />date is indicated below, <br />{The fallowing "eabacd ing cruse" need be completed only when 4hls enikfrserrent is Issuer! subsequent In preParstiurr of the pol(cy). <br />This endorsement, effective 12:01 AM 01 /D112016 forms ra part of Policy No, WC 068-02.2119:3 <br />Issued to SCHNEIDER ELECTRIC HOLDINGS, INC. <br />By NEW HAMPSHIRE INSURANCE COMPANY <br />We have o right to recover our payments from anyone liable for an Injury covered by this policy, We will not enforce <br />our right agarinw any person or organization with whom you have a written contract that resgadre,s you to obtain this <br />agreement from us, as regards any work you perform for such person or organization. <br />The additional premiurn for this endorsement shall be 2, 00 % of the total estimated workers compensation premium <br />for this policy. <br />PVC pd 03 01 Countersignodl by ................ ... - _ - - _ - _ ' , <br />(Eat.11190) _ - - -- <br />Authorized Representative <br />