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%Porkers' Compensation and Lmpinycrs' Liabl6nv Policy <br />'hJmvd 111a ed <br />I ?nua: umni Sumoei —..— - -I <br />TYCO INTERNATIONAL MANAGEMENT COMPANY, <br />LLC <br />--- - - ---- -.i <br />Pchca tiNUhcr __ . <br />9 ROSZEL ROAD <br />Spmbol WLR Nmnb�i C48592272 <br />PRINCETON NJ 08540 <br />l uliry terinl <br />fffmcti,e Uae ofLndoisemurn <br />10-01 -2015 TO l 0 -01 2016 _ <br />_ _. <br />10-01-2015 <br />14411'.41 By (1 lIY1G Ui 1IIiPI'tlpVC fOlY1j1141 }t <br />INDEMNITY INS CO OF NORTH AMERICA <br />In +Gn thr itoh numb _Tla i. n.tiudcrtrftlt m6nnnnirn ivt i n mhn lhiscnli mntnt.rud ib luau io ih i rn.man rih Llicv I <br />UTAH WAIVER OF SUBROGATION EiNDORSENflENT <br />This endorsement applies only to the insurance provided by the policy becausc Utah is shown in Itern 3.A. of' the Information <br />Pagc. <br />We have the right to recover our payments from anyone liable Tor an iq}ury covered by this policy. We Will not unfoce our right <br />against the person or organization named in the Schedule. (This agreeunmrt Etpplius only to the extent that ,von perform work <br />under a written contract that requires you to obada this agreement from u s.) <br />This agrccmcnt shall not operate directly or indirectly to benefit anyone not named in the schedule. Our waiver ol'rights does <br />not icleasc your emplovices' rights against third parties and does not release our authority as trustee of claims against third <br />patties. <br />ScheciLLle <br />ANY PERSON OR ORGANIZATION AGAINST WHOM YOU HAVE AGREED TO WAIVE YOUR RIGHT OF RECOVERY IN A <br />WRITTEN CONTRACT PROVIDED SUCH CONTRACT WAS EXECUTED PRIOR TO THE DATE OF LOSS. <br />r <br />Authorized Ag ll — __�.... <br />NV( '.t 3 01 05 (11.00) Ptd. in U.S.A. <br />