WORKER3 COMPEKSATION MID EMPLOYERS LIABILITY IN3URWACE POLICY WC 00 03 13
(Ed. 04-94)
WAIVER OF OUR RIGHT TO RECOVER FROM OTHER ENDORSEMENT
We have the eight to recover our payments from arryone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (Thie agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.)
This agreement shall not opener directly or indirectly to benefit anyone not named 3n the Schedule.
Schedule
Any person or organization to whom you become obligated to waive your rights of recover/ against, under any contract or agreement you enter into prior to the occurrence of loss.
This endorsement *lenges the policy to % it is at*ochob end a effective on the dale issued unless otherwise ebtcd.
Mee ineermel!on toilota is required ani► when mire tdc wn Is teemed eit,ogrerd to pr tion at the policy-) Endorsemeri Effective: Policy No.:
insured. Premium:
Insurance Company:
WCUOt313
(Ed. 04.84)
Endoneemant
.:
Countersigned Cry:
Pegs 1 of 1