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I PCA!' LER rJ WORKERS COMPENSATION <br />AND <br />EMPLOYERS LIABILITY POLICY <br />ENDORSEMENT WC 00 03 13 (OPJ)_, <br />POLICYNUMBER: TC2JUB-744aL2'7-I-Ie <br />WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT <br />We have the right to recover our paymants 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 appiies 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 shell rot operate directly or indirectly to benefit any one not named in the Schedule. <br />SCHEDULE <br />DESIGNATED PERSON: <br />DESIGNATED ORGANIZATION: <br />ANY PERSON OR ORGANISATION FOR WHOM A WA=,R or <br />SUBROGATION IS REQUIRED BY CONTRACT OR AC"EMENT OR <br />PERMIT, BUT COVERAGE IS LIMITED TO THE SCOPE Or THE <br />WORK PERFORMED BY THE INSURED UN"R SUCH CONTRACT, <br />AOREPMENT OR. PERMIT, <br />rro"TD AS To FORM' <br />raaey <br />DATEOFISSUE: 09-14-15 STASSIGN: <br />