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.A. <br /> TRAVELERS J WORKERS COMPENSATION <br /> AND <br /> ONE FOC0 <br /> BARTPORDRD, CTT 06183 <br /> EMPLOYERS LIABILITY POLICY <br /> ENDORSEMENT WC 00 03 13(00)-01 <br /> POLICY NUMBER: UB-2j440716-17-26 <br /> WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT <br /> We nave 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 /> DESIGNATED PERSON: <br /> DESIGNATED ORGANIZATION: <br /> ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS <br /> AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO <br /> FURNISH THIS WAIVER. <br /> DATE OF ISSUE,04/01/2018 ST ASSIGN: <br />